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Can J Surg. 1997 Aug;40(4):278-83.

Hinge total knee replacement revisited.

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1
Department of Surgery, University of Toronto, Ont.

Abstract

OBJECTIVE:

To determine if aseptic loosening is a major problem in hinge total knee replacement.

DESIGN:

A cohort study.

SETTING:

A university-affiliated institute, specializing in elective orthopedic surgery.

PATIENTS:

Fifty-eight patients, mainly those requiring revision, in whom the conditions were such that it was felt only a totally constrained implant was appropriate. In 7 patients the implant was press-fitted; in the remainder it was cemented. Five patients required fusion or revision, and 8 died less than 2 years after implantation, leaving 45 for review. Follow-up was 2 to 13 years.

INTERVENTION:

Total knee replacement with a Guepar II prosthesis.

MAIN OUTCOME MEASURES:

Radiolucency determined by the Cameron system and clinical scoring using the Hospital for Special Surgery system.

RESULTS:

Of the cemented components, 91% of femoral stems were type IA (no lucency), 9% were type IB (partial lucency), with no type II or III lucency. Tibial lucency was 87% type IA and 13% type IB, with no type II or III lucency. Of the noncemented components, 58% of femoral components were type IA and 42% type IB. Tibial lucency was 71% type IA and 29% type IB. Lucency was mainly present in zones 1 and 2 adjacent to the knee. Clinical rating was 18% excellent, 20% good, 20% fair and 42% poor. Postoperative complications included infection (13%), aseptic loosening (7%), quadriceps lag (16%) and extensor mechanism problems (16%).

CONCLUSIONS:

Aseptic loosening is an uncommon problem in hinge total knee replacement. The complication rate in cases of sufficient severity as to require a hinge replacement remains high. Current indications for a hinge prosthesis are anteroposterior instability with a very large flexion gap, complete absence of the collateral ligaments and complete absence of a functioning extensor mechanism.

Comment in

PMID:
9267296
PMCID:
PMC3949932
[Indexed for MEDLINE]
Free PMC Article
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