title: Dislocation of rotating hinge total knee prostheses. A biomechanical analysis.
abstract: BACKGROUND
  Symptomatic instability and implant dislocation are occasionally encountered in patients with a rotating hinge total knee prosthesis. A biomechanical study of rotating hinge total knee implants was performed to determine the association between the design (length and taper) of the central rotational stem and the stability of the implant.
  
  
  METHODS
  The stem lengths and tapers of knee implants made by seven manufacturers were measured. The tilting laxity of each design was tested by measuring the degree of tilting of the central rotational stem within the tibial housing that occurred with increasing amounts of distraction. The maximum amount of distraction that was possible before the stem dislocated was determined for each design.
  
  
  RESULTS
  Implant designs with a short and/or markedly tapered central rotational stem had the greatest tilting, laxity, and instability of that stem. The Howmedica, Techmedica, Intermedics/Sulzer Medica, and Wright Medical Technology/ Dow Corning Wright designs required > or = 39 mm of distraction before they dislocated. The Biomet knee implant required 33 or 44 mm of distraction to dislocate, depending on the thickness of the polyethylene tray that was utilized. The S-ROM knee required only 26 mm of distraction before dislocation occurred.
  
  
  CONCLUSIONS
  The measurements confirmed that the shorter the stem and the greater its taper, the greater the instability and laxity at any given amount of joint distraction.
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157-1070, USA. wgward@wfubmc.edu
authors.forename: William G
authors.initials: WG
authors.lastname: Ward
authors.forename: David
authors.initials: D
authors.lastname: Haight
authors.forename: Paul
authors.initials: P
authors.lastname: Ritchie
authors.forename: Stan
authors.initials: S
authors.lastname: Gordon
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Eckardt
mesh_terms: D001696:Biomechanical Phenomena; D006801:Humans; D066298:In Vitro Techniques; D004204:Joint Dislocations / Q000503:physiopathology; D007593:Joint Instability / Q000503:physiopathology; D007720:Knee Prosthesis; D011474:Prosthesis Design; D011475:Prosthesis Failure