Custom-made hinged total knee arthroplasties in the context of extra-articular deformity: a case series

• Published in: European journal of orthopaedic surgery & traumatology Vol. 33; no. 4; pp. 1411 - 1420
• Main Authors: Nuutinen, Timo K., Madanat, R., Både, K. W., Ristolainen, L. H., Kauppinen, H., Manninen, M. J.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.05.2023; Springer Nature B.V
• Subjects: Arthroplasty, Replacement, Knee - adverse effects; Clinical outcomes; Humans; Knee; Knee Joint - surgery; Knee Prosthesis; Medicine; Medicine & Public Health; Middle Aged; Original; Original Article; Osteoarthritis, Knee - surgery; Patients; Range of Motion, Articular; Retrospective Studies; Surgical Orthopedics; Traumatic Surgery; Knee surgery; Arthroplasty; Deformity; Custom-made
• ISSN: 1432-1068; 1633-8065; 1432-1068
• DOI: 10.1007/s00590-022-03299-8

Purpose Treatment of secondary knee osteoarthritis with a significant extra-articular deformity can be challenging. In such cases, an osteotomy or a custom-made hinged knee arthroplasy (CMH) are treatment options. However, there are limited data on the outcomes of using CMHs. Thus, the aim of this retrospective study was to assess the clinical results and subjective outcomes of CMHs. Methods We reviewed 9 CMHs (Endo-Model, LINK) in 7 patients with a minimum of 2-year follow-up. Upon the last follow-up, we evaluated MA, stability and range of movement (ROM). Oxford Knee Score (OKS) was used to evaluate patient-reported outcomes. Results The average age upon surgery was 61 years (48–76 years), and the follow-up period was 66 months. There were no early complications. Two CMHs were revised, one due to aseptic loosening and one due to late-onset haematogenic infection. Pre-operatively, MA varied from 18° (average 11°) valgus-deformity to 30° (average 17°) varus-deformity. Post-operatively, 7/9 (78%) of patients achieved better MA. Upon follow-up, the average OKS was 41/48, and ROM was 113°. Conclusions Patients treated with CMHs achieved good clinical and patient-reported outcomes. There were no early reoperations, and revision rate was relatively low. Overall, CMH could be considered for low-demand patients with increased operative risks.