Long term outcome of total knee arthroplasty rotating hinge designs

Abstract

At the dawn of knee arthroplasty (TKA), in the early 1950s of last century, prostheses were exclusively simple hinges, moving only on the sagittal plane and lacking any rotation. Pioneer prostheses were the Walldius (1951) and the Stanmore (1952) knees. Later, the Shiers (1954), Young (1963), St. Georg (1970) and Guepar prostheses (1970) were used [1-3]. All of these were first generation hinges (Figs. 19.1, 19.2, 19.3, and 19.4). Some hinges followed the low friction principle, like the Blauth prosthesis (Fig. 19.4) and other adopted low friction too but reminding more of a CCK design, like the Sheehan knee (Fig. 19.5) [1, 4]. Initially, failure rates were high and were attributed to excessive torsional and shearing forces acting on the bone cement interface. Aseptic loosening frequently occurred and structural failure of the components was occasionally appeared [2, 3, 5-11]. Wear particles, originating from the articulating metallic surfaces, were often contributed to osteolysis process and subsequent loosening [6, 9]. In addition, infection and periprosthetic fractures were frequently seen, and when such an arthroplasty failed, revision or arthrodesis became very demanding procedures due to extensive bone resection during index surgery [8-10, 12, 13]. © Springer-Verlag London 2015.