Indications for primary rotating-hinge total knee arthroplasty. Is there consensus?

The use of rotating-hinge systems in total knee arthroplasty is most often seen in revision setting where excessive bone loss, ligamentous instability and/ or extensor mechanism dysfunction may necessitate an increased level of component constraint. However, this implant type is also being increasingly used in the primary setting. The aim of this study is to review literature concerning the use of third generation rotating-hinge devices focusing on the indications for primary cases. Literature was searched for following search terms: total knee arthroplasty, primary indication, constraint, rotating hinge knee, knee prosthesis, hinged knee, total knee replacement. Additional papers were identified by screening references and similar articles. All papers dealing with first or second generation rotating-hinge implants and revision cases were discarded. After conducting a large literature search, we concluded that third generation rotating-hinge implants should be considered in limited indications in which ligamentous tibiofemoral instability is the core indication.