COPYRIGHT © 2003 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED Dislocation of Rotating Hinge Total Knee Prostheses

Background: Symptomatic instability and implant dislocation are occasionally encountered in patients with a rotat-ing hinge total knee prosthesis. A biomechanical study of rotating hinge total knee implants was performed to deter-mine 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 hous-ing that occurred with increasing amounts of distraction. The maximum amount of distraction that was possible be-fore 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 ≥39 mm of distraction before they dislocated. The Biomet knee implant re-quired 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 insta-bility and laxity at any given amount of joint distraction