JOA - 2026-06-18 - Journal Article
Rotating-Hinge Revision Total Knee Arthroplasty for Arthrofibrosis Improves Motion Without Increasing Complications: A Systematic Review and Meta-Analysis.
Ruelos VCB, Jayarajan NA, Shi JL, Elias TJ, Wainwright JD, Horani K, Tansey PJ
Topics
Key Takeaway
Rotating-hinge revision TKA for arthrofibrosis yields a pooled ROM improvement of 42.2° and a 17.5° advantage over non-hinged revision constructs without increased complications.
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Summary
This PRISMA 2020-compliant systematic review and meta-analysis asked whether rotating-hinge implants improve ROM more than non-hinged revision constructs when used for arthrofibrosis. Seven studies (2005–2025) were pooled using random-effects models; RH revision produced a mean ROM gain of 42.2° (95% CI 32.3–52.1°, P<0.0001) and outperformed NHR by 17.5° (95% CI 6.6–28.4°, P=0.002). No included study demonstrated a higher complication or reoperation rate with RH implants.
Key Limitation
The comparative analysis rests on only four studies with 332 patients total, and baseline ROM, extent of soft-tissue release, and follow-up duration are inconsistently reported across studies, making the between-group ROM difference difficult to interpret in isolation.
Original Abstract
INTRODUCTION
Arthrofibrosis remains a challenging indication for revision total knee arthroplasty (rTKA), frequently resulting in persistent stiffness and limited postoperative range of motion (ROM). Rotating-hinge (RH) implants are often selected in this setting to allow for aggressive soft-tissue release and improved stability; however, the magnitude of ROM improvement and comparative effectiveness versus non-hinged revision (NHR) constructs remain incompletely defined.
METHODS
A systematic review and meta-analysis were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, Scopus, and the Cochrane Library were searched from 2005 to 2025 to identify studies reporting outcomes of rTKA performed for stiffness or arthrofibrosis. There were seven studies that met inclusion criteria, encompassing 224 rotating-hinge revisions, including four comparative studies evaluating RH versus NHR implants and three RH-only case series. Random-effects meta-analyses were conducted to evaluate pooled improvement in ROM following RH revision and to compare ROM change between RH and NHR constructs. Heterogeneity was assessed using the I 2 statistic.
RESULTS
The RH revision TKA group resulted in a significant pooled improvement in ROM of 42.2° (95% confidence interval (CI), 32.3 to 52.1; P < 0.0001). Comparative analysis of four studies (224 RH versus 108 NHR revisions) demonstrated significantly greater ROM improvement with RH implants, with a pooled between-group difference of 17.5° favoring RH constructs (95% confidence interval (CI), 6.6 to 28.4°; P = 0.002). There was no included study that demonstrated an increased complication or reoperation burden associated with RH implants.
DISCUSSION AND CONCLUSION
Revision TKA using rotating-hinge implants for arthrofibrosis provides substantial and clinically meaningful improvements in knee ROM. Compared with non-hinged constrained revision constructs, RH implants yield significantly greater gains in motion without an apparent increase in complications or reoperations, supporting their use in the management of severe stiffness.