• Arch Orthop Trauma Surg · Jan 2023

    The anatomical shape of the distal femur is an independent risk factor for aseptic loosening following one-stage septic knee revision using rotating hinge knee prosthesis.

    • Timo Scholz, Mustafa Akkaya, Philip Linke, Sophia-Marlene Busch, Thorsten Gehrke, Jochen Salber, and Mustafa Citak.
    • Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
    • Arch Orthop Trauma Surg. 2023 Jan 1; 143 (1): 481488481-488.

    PurposeAseptic loosening (AL) is the second most common reason for failure after one-stage septic knee revision. In this context, the goal of the study is to identify risk factors for AL following one-stage septic knee revision using rotating hinge implants. We aimed to answer the following research question: How does the anatomical shape of the distal femur represent an independent risk factor for AL following one-stage septic knee revision arthroplasty?MethodsPatients, who had undergone re-revision surgery due to AL of the rotating hinge knee prosthesis after one-stage septic knee revision arthroplasty between January 2008 and December 2018, were included. For this purpose, 41 patients with AL after one-stage septic knee revision using rotating hinge implants and 37 controls without any revision surgery at latest follow-up were included in this study. Using standardized anteroposterior (AP) views of the knee in all patients, we measured the inner diameter of the femur 20 cm proximally from the joint line and at a point 2 cm proximally from the adductor tubercle.ResultsAmong the vast majority of AL cases, we identified an isolated loosening of the femoral component. The AL group showd a high distribution of the Type C according to the Citak classification with 75.7%. Contrary to this, with 24.3% (p < 0.001) the amount of Type C cases was relatively low in the control group. Consequently, Type C configurations of the distal femur represent an independent risk factor for AL with an approximately sevenfold higher risk for AL compareed to Type A and Type B.ConclusionsThe novel radiological classification system of the distal femur shows that the Type C subtype is an independent and main risk factor for AL after one-stage septic knee revision using rotating hinge knee implants.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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