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Evolution of the rotating hinge for complex total knee arthroplasty.

P. K. is an 83-year-old male with a history of multiple health comorbidities and multiple revision right total knee arthroplasty (TKA) with a rotating hinge implant, who presented to our institution's emergency room with progressively worsening right knee pain causing instability and inability to ambulate after sustaining a fall while walking outdoors one month prior. The patient underwent total knee revision surgery 1 year prior at an outside institution where a DePuy S-ROM rotating hinge implant was used. Physical examination was limited due to gross deformity of the right knee. Neurovascular examination was intact with good distal pulses and an ankle brachial index >0.9. Radiographs revealed a posterior dislocation of the hinge post of the right total knee arthroplasty; the post was in close proximity to the location of the popliteal neurovascular structures (). A lower extremity CT angiography showed intact vascular structures. Infection workup showed an increase in ESR and CRP however, fluid cultures and cell counts with differential from joint aspirate were unremarkable. Intraoperative findings confirmed a disengaged hinge that dislocated on flexion (Figures and ) and a laterally dislocated patella. The mobile hinge components were removed and replaced with an extra-extra small-size bumper and a 12mm tibial insert (). Extensive lateral release was performed to centralize the laterally dislocated patella and restore proper patella tracking. Intraoperative arc of motion after revision of the hinge components was 0° to 90° against gravity, and no instability could be elicited. Postoperatively, the patient was placed in a hinged brace locked in full extension. At his one-month followup, he was ambulating painlessly with the assistance of a cane and demonstrated flexion up to 100°. Postoperative imaging showed a well-seated implant with no signs of loosening, fracture, dislocation, or wear. The patient was doing well on his 3-month and 1-year followup, ambulating with no assistive devices with good range of motion and no further instability and complications. The patient gave informed consent for the case to be published.

rotating hinge prosthesis for complex knee arthroplasty.

The invention relates to the field of medical equipment and prosthetics and protestosterone
Known kinematic hinge node knee prostheses and orthoses to provide restraint (jamming) of the hinge in a wide range mismanage corner [1]
The disadvantages of this hinge are discrete lock, allowing you to jam the hinge through certain angles of rotation of the heads of the tires of the first and second parts of the hinge, and the fact that he flat hinge, and not spherical.The closest in technical essence is the kinematic hinge knee host of lower-limb prosthesis containing a circular drum, the inner and outer clamping elements providing stepless one-way jamming [2]
The disadvantages of the prototype are the dependence of jamming on the value of the reference reaction, a narrow range mismanage angle, which results in jamming of the hinge, the loud click when it rasklinivanie and the fact that it is flat, not spherical hinge.The aim of the invention is the creation of spherical kinematic joint with stepless fixation of rotation around two axes and the adjustable toogoodtobetrue, elbow, shoulder), allowing for the design of upper limb prostheses significantly extend their functionality with self-service and in-work of the patient due to the adjustable stiffness rotation, reliable fixation (jamming) of rotation of the spherical hinge around two axes (up to fracture) and free silent its wedging after removal of the load.This goal is achieved by the fact that spherical kinematic joint consists of the drum of the first link of the hinge with the contact surface in the form of a sphere whose center is the center of rotation of the hinge, raspolozhennogo split inside the cage of the second link hinge with screw adjust the stiffness of rotation of the hinge and the wedge with the response, the contact surface connected to the elastic element and the second spherical contact surface with the focus going from the clip spring pressed and resting in rusticator that by spring of respirator provides continuous contact between the spherical drum and wedge.The above signs, providing continuous jamming of the spherical kinematic joint around narozena in science and technology before the date of filing, that meets the requirement of "novelty".

Evolution of the rotating hinge for complex total knee arthroplasty

to rigid or rotating-hinge prostheses for complex knee reconstructions ..

The invention relates to the field of medical equipment and prosthetics and protestosterone.Known kinematic hinge node knee prostheses and orthoses to provide restraint (jamming) of the hinge in a wide range Misonix angles [1]
The disadvantage of this hinge is the discreteness of his fixation, allowing you to jam the hinge through certain angles of rotation of the heads of the tires of the first and second parts of the hinge.The closest in technical essence to the invention is the kinematic hinge knee host of lower-limb prosthesis containing a circular drum, the inner and outer ring elements, providing one-way continuous jamming [2]
The disadvantages of the prototype are the dependence of jamming on the value of the reference reaction, a narrow range mismanage knee angle, which results in jamming of the hinge, and a loud click when it rasklinivanie.The aim of the invention is the creation of a kinematic hinge for simulators joints of upper limb prostheses that significantly improve their functional and cosmetic properties and to expand the range of functions is Onego, but with the switch in the direction of the jamming of the hinge and the free silent its wedging in the absence of loads jamming.This goal is achieved by the fact that the kinematic hinge holds the drum of the first link of the hinge with the contact surface in the form of rotation of a body connected with the second link hinge axis which is the axis of rotation of the hinge, and a wedge with two reciprocal contact surfaces connected to the second link hinge axis, and switch directions jamming connected axis with the second component of the elastic hinge element for ensuring continuous contact between the drum and one of the contact surfaces of the wedge depending on the position of the switch.The above signs, providing one-way switchable jamming kinematic joint throughout the range of flexion, extension and free silent rasklinivanie in the absence of external loads on jamming, is not found in science and technology prior to the filing date of an application that meets the requirement of "novelty".

In these difficult situations, the choice to proceed with resection of the distal femur seems to result in good survivorship and function. However, rerevision or failure of these devices is complex and may result in an unsalvageable situation. Therefore, while caution is advised, distal femoral replacement seems a reasonable option in these difficult cases that, fortunately, represent a small percentage of our TKA volume. Our data support the continued use of a modular rotating-hinge knee system in cases of complex knee reconstruction similar to those described with severe instability and massive bone loss, complex primary TKA, periprosthetic fracture, or acute distal femoral fracture in elderly patients in addition to the standard tumor uses. As the revision burden increases, so will the number of multiple revision surgeries and the complexity of revision procedures, making the need for these devices likely to grow.

The Kinematic Rotating Hinge Prosthesis for Complex ..

The kinematic rotating hinge prosthesis for complex knee arthroplasty.

The rotating hinge knee prosthesis is a popular intervention in patients lacking stability with highly constrained total knee arthroplasty. Despite improvements in design, nonmechanical and mechanical complications continue to be a problem. Dislocation of the hinge has been widely described, mainly due to the component fracture. Few reports describe isolated dislocation of the rotating stem. We report a case of isolated disengagement of the rotating hinge mechanism, due to severe flexion gap imbalance, leading to subsequent posterior dislocation of the hinge and anterior knee dislocation, in a patient with a history of multiple total knee arthroplasty revisions. This case suggests the importance of the soft tissue balancing, the adequate patellar tracking, and use of a long cylindrical, minimally tapered rotating stem in hinge arthroplasty to minimize hinge dislocation.

The invention relates to the field of medical equipment and prosthetics and protestosterone.Known kinematic hinge node knee prostheses and orthoses to provide restraint (jamming) of the hinge in a wide range mismanage corner [1]
The disadvantages of this hinge are discrete lock, allowing you to jam the hinge through certain angles of rotation and the heads of the tires of the first and second parts of the hinge, and the fact that it is flat, not spherical hinge.The closest in technical essence to the invention is the kinematic hinge of the knee angle of the lower-limb prosthesis containing a circular drum, the inner and outer clamping elements providing stepless one-way jamming [2]
The disadvantage of the prototype is the dependence of the jamming from the values of the support reactions, the narrow range mismanage angle, which results in jamming of the hinge, the loud click when Zack is adicheskogo spherical hinge with adjustable fixing of rotation around the three axes and adjustable stiffness rotation for simulators joints of the upper extremities (the third joint of the big toe wrist, elbow, shoulder), allowing for the design of upper limb prostheses significantly extend their functionality with self-service and in-work of the patient due to the adjustable stiffness rotation, reliable fixation (jamming) of rotation of the spherical hinge around the three axes (up to fracture) and free silent its wedging after removal of the load.This goal is achieved by the fact that spherical kinematic joint consists of the drum of the first link of the hinge with the contact surface in the form of a sphere whose center is the center of rotation of the hinge that is located in a slotted holder of the second link hinge with screw adjust the stiffness of rotation of the hinge and wedges with mating contact surfaces connected by the elastic element and the second spherical contact surfaces with a focus going from the clip spring pressed and resting in rusticator that by spring of respirator provides continuous contact between the spherical drum and wedges.The above signs, providing continuous jamming of the spherical kinematic is supplying the load, not found in science and technology prior to the filing date of an application that meets the requirement of "novelty".

Total Knee Arthroplasty Using the Kinematic Rotating Hinge Prosthesis
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The kinematic rotating hinge prosthesis for ..

Wide exposure is crucial to allow component removal, bone reconstruction, and reimplantation while reducing operative time and risks. We describe a novel technique used with two patients to gain exposure for revision and implantation of rotating hinge knee prosthesis. At 2-year follow-up, the patient walked painlessly, without the use of assisting devices and had a postoperative range of motion of 0 to 110–110 degrees.

Complex Total Hip Arthroplasty.

Severe distal femoral bone loss and instability in revision TKA is challenging. We retrospectively reviewed 39 rotating-hinged distal femoral replacement devices in 37 patients to examine whether improved results were obtainable, using one design, over previously published results. The average age of the patients was 76 years (standard deviation, 10 years). Indications for distal femoral replacement included 11 revision TKAs, 13 periprosthetic fractures, 11 reimplantations, two complex primary TKAs, one distal femoral nonunion, and one acute distal femur fracture. Minimum followup was 24 months (mean, 46 months; range, 24–109 months). Eight patients died during followup. There were five reoperations: two patients with recurrent infection after two-stage treatment, one patient with a periprosthetic fracture treated by open reduction and internal fixation, one patient with late hematogenous infection, and one patient with bearing exchange to treat hyperextension. No failures from aseptic loosening were seen. Knee Society scores improved from 39 preoperatively to 87, and pain scores improved from 18 preoperatively to 43. Distal femoral prosthetic replacement with a tumor-type implant in severe cases provides excellent pain relief and function with a low short-term reoperation rate and an implant survivorship rate of 87% at 46 months.

Failure of the Rotating-Hinge Knee Megaprosthesis, …

Published results using the rotating-hinged knee implants for nontumor reconstruction have varied from acceptable to poor (Table ). Whether these differences relate to specific design features or the general concept of a rotating-hinged implant is unclear. To address the controversy, we sought to answer the following question: Does a contemporary design modular rotating-hinged TKA prosthesis provide acceptable results in terms of implant survivorship and clinical outcomes at short-term when compared with published results?

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