Contemporary Rotating Hinged Prostheses in Primary Total Knee Arthroplasty

The use of hinged prostheses in total knee arthroplasty (TKA) has been historically reserved for complex revision scenarios. However, the use of these implants in primary TKAs has increased over the past few decades largely attributed to improvements in implant design and materials. Although the indications for hinged prostheses in primary TKA remain controversial, the use of hinged prostheses may be warranted in certain patients whose pathology precludes the use of implants with lesser constraint. While infection and aseptic loosening remain the most common complications, mid-term outcomes and survivorship of modern rotating hinges, particularly in elderly patient populations, appear comparable to implants with lesser constraint. This chapter discusses the evolution of hinged prosthesis designs, current surgical technique for this procedure, indications for hinges in contemporary primary TKA, as well as the clinical outcomes and complications associated with these implants.