title: Hinge total knee replacement revisited.
abstract: OBJECTIVE
  To determine if aseptic loosening is a major problem in hinge total knee replacement.
  
  
  METHODS
  A cohort study.
  
  
  METHODS
  A university-affiliated institute, specializing in elective orthopedic surgery.
  
  
  METHODS
  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.
  
  
  METHODS
  Total knee replacement with a Guepar II prosthesis.
  
  
  METHODS
  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.
authors.affiliation: Department of Surgery, University of Toronto, Ont.
authors.forename: H U
authors.initials: HU
authors.lastname: Cameron
authors.forename: C
authors.initials: C
authors.lastname: Hu
authors.forename: D
authors.initials: D
authors.lastname: Vyamont
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation