This document discusses rotating hinge knee arthroplasty indications and results, focusing on patellar complications. Rotating hinge implants connect the femoral and tibial components with a rotating hinge to compensate for ligament deficiencies. Indications include primary TKA for valgus/varus deformity, revision for bone loss or instability. Analysis of 43 patients found 65% had optimal patellar positioning, 28% were tilted, and 7% subluxated/dislocated. Secondary procedures were needed in 5% to address patellar issues. Rotating hinge implants represent 25% of revision TKA indications at the author's hospital, with satisfactory flexion but some patellar complications.

1. Indications and current
résults of rotating hinge
arthroplasties.
Patellar issues.
LUSTIG Sébastien MD, PhD, Prof
Albert Trillat Center
Lyon North University Hospital
LYON - FRANCE

2. AIM
• CURRENT INDICATIONS OF ROTATING HINGE
ARTHROPLASTY
• SPECIFIC ASSESSMENT OF PATELLAR
COMPLICATIONS

3. Principles
« … »L’implant
fémoral et l’implant
tibial sont liés entre
eux par un moyen
d’union de type
charnière palliant la
déficience des
formations
ligamentaires du
patient.
Cette charnière est
fixe ou rotatoire.
« … »

4. Problems :
• Increase bony stress
•Long stem is needed
More constraints…

5. indications ?
Avec défaillance ligamentaire
Arthroplastie tricompartimentale
Sans perte de substance osseuse

6. Indications?
Arthroplastie tricompartimentale
Avec perte de substance osseuse
Avec défaillance ligamentaire Avec défaillance ligamentaire

7. CHU Lyon Croix Rousse
Total UKA TKA RTKA R Hinge
2013 410 19 359 32 12
2014 523 38 444 41 15
2015 633 50 513 70 29
2016 651 54 495 102 43
TOTAL 2217 161 1811 245 96
4% indications

8. Indications
• Primary TKA:
– Valgus (LCM)
– Varus (severe +++) / eldearly patient
– Desarthrodesis TKA
– Polyomyelitis …
• Revision :
– Bone loss (ligaments ?)
– Patella Baja
– FT instability
– Stiffness ++

9. Valgus

10. - Seems stable in EXT.
- Laxity in flexion (#20-30°)
Valgus

13. Varus ?
?
?

14. Varus

15. « Desarthrodesis » TKA

17. Polyomyelitis (n=2)

18. Indications
• Primary TKA:
– Valgus (LCM)
– Varus (ssevere +++) / eldearly patient
– Desarthrodesis TKA
– Polyomyelitis …
• Revision :
– Bone loss (ligaments ?)
– Patella Baja
– FT instability
– Stiffness ++

19. Revision for instability ++

21. Postoperative Xrays

22. Patella Baja

23. infections

24. 1-Stage / 2-stage

25. Results

26. Patella ?

27. CHU Lyon Croix Rousse
Total UKA TKA RTKA R Hinge
2013 410 19 359 32 12
2014 523 38 444 41 15
2015 633 50 513 70 29
2016 651 54 495 102 43
TOTAL 2217 161 1811 245 96
4% indications

28. Type of R Hinge TKA
Simple
• Rotax (Groupe Lepine ®)
Reconstruction
• Noyles (Depuy®)
• RHK OSS (Biomet®)
n=43 N=29
n = 72

29. Patellar analysis
• X ray: pattelar view at 30° flexion
• 4 groups:
– Centered
– Tilted
– Subdislocated
– Dislocated

30. Type of R Hinge TKA
Simple
• Rotax (Groupe Lepine ®)
Reconstruction
• Noyles (Depuy®)
• RHK OSS (Biomet®)
65% 59%
28,1%
6,9%4,6 %
2,3 % 2,3 %
31,8 %

31. Type of R Hinge TKA
Simple
• Rotax (Groupe Lepine ®)
Reconstruction
• Noyles (Depuy®)
• RHK OSS (Biomet®)
65% 59%
28,1%
6,9%4,6 %
2,3 % 2,3 %
31,8 %
93,1% 90,8%

32. Type of R Hinge TKA
Simple
• Rotax (Groupe Lepine ®)
Reconstruction
• Noyles (Depuy®)
• RHK OSS (Biomet®)
65% 59%
28,1%
6,9%4,6 %
2,3 % 2,3 %
31,8 %

33. ATT medialisation+ MPFL
n = 2

34. Conclusion
• 25% of our current indications for
Revision TKA,
• Satisfactory functional results
(flexion),
• 65% optimal Patellar positioning,
• 5% secondary MPFL + ATT
medialisation.