旋转铰链型人工膝关节置换治疗胫骨近端骨肿瘤

目的 探讨定制旋转铰链型人工膝关节置换治疗胫骨近端骨肿瘤的临床效果.方法 对14例胫骨近端骨肿瘤患者(骨巨细胞瘤8例,动脉瘤样骨囊肿1例,转移性肿瘤2例,骨肉瘤3例)采用定制旋转铰链型人工膝关节置换重建,骨肉瘤同时采用新辅助化疗治疗.结果 患者切口均一期愈合,无皮肤感染及坏死发生.14例均获随访,时间12~68个月.膝关节功能采用Enneking标准进行评定:优8例,良4例,差2例.1例骨肉瘤患者术后48个月因肺转移死亡;2例转移性骨肿瘤患者局部无复发,但分别在术后9个月及24个月死于原发肿瘤;1例患者50个月后出现假体松动,翻修后效果良好;其余患者生活质量良好.结论 定制旋转铰链型人工膝关节置换治疗胫骨近端骨肿瘤能保留良好的关节功能,是有效的保肢方法.     

人工假体置换在膝关节周围侵袭性骨肿瘤中的应用

目的: 探讨人工假体在膝关节周围原发侵袭性骨肿瘤保肢术中的临床应用效果。方法: 膝关节周围原发侵袭性骨肿瘤患者 42例。其中股骨远端 24例, 胫骨近端 16例, 腓骨上端 2例。病理类型: 骨肉瘤 21例, 骨巨细胞瘤 (Ⅱ~Ⅲ级) 16例, 软骨肉瘤 4例, 滑膜肉瘤 1例。行骨肿瘤的广泛切除或根治性切除后, 采用人工膝关节假体置换重建, 对骨肉瘤患者同时采用新辅助化疗治疗。结果: 42例患者术后随访 12~72个月, 其中 30例患者无局部复发或远处转移, 12例出现复发。膝关节活动范围: 伸 0°, 屈 85 ~120°。按Enneking法评定功能, ≥23分 22例, 15~22分 17例, <15分 3例, 优良率达到 86%。结论: 人工假体是一种治疗膝关节周围恶性骨肿瘤较好的保肢方法, 能降低局部并发症及提高临床疗效。     

可旋转稳定型假体与单纯铰链型假体治疗胫骨近端恶性骨肿瘤的临床疗效比较

[目的]比较应用可旋转稳定型人工膝关节假体与单纯铰链型假体治疗胫骨近端恶性骨肿瘤的临床疗效。[方法]回顾性分析2009年6月²012年10月间在本院行可旋转稳定型膝关节假体(A组)和单纯铰链型假体(B组)治疗的胫骨近端恶性骨肿瘤患者的临床资料。A组:男10例,女7例,平均年龄26.5岁,其中骨肉瘤7例,软骨肉瘤5例,侵袭性骨巨细胞瘤4例,恶性纤维组织细胞瘤1例;B组:男16例,女5例,平均年龄28岁,其中骨肉瘤11例,软骨肉瘤4例,侵袭性骨巨细胞瘤3例,纤维肉瘤3例。手术对胫骨近端肿瘤进行广泛切除或根治性切除后,采用假体重建膝关节;对化疗敏感的病例同时采用新辅助化疗治疗。置换后采用Enneking膝关节评分标准对膝关节功能进行评估,并记录膝关节屈伸度数。[结果]A组随访72012年10月间在本院行可旋转稳定型膝关节假体(A组)和单纯铰链型假体(B组)治疗的胫骨近端恶性骨肿瘤患者的临床资料。A组:男10例,女7例,平均年龄26.5岁,其中骨肉瘤7例,软骨肉瘤5例,侵袭性骨巨细胞瘤4例,恶性纤维组织细胞瘤1例;B组:男16例,女5例,平均年龄28岁,其中骨肉瘤11例,软骨肉瘤4例,侵袭性骨巨细胞瘤3例,纤维肉瘤3例。手术对胫骨近端肿瘤进行广泛切除或根治性切除后,采用假体重建膝关节;对化疗敏感的病例同时采用新辅助化疗治疗。置换后采用Enneking膝关节评分标准对膝关节功能进行评估,并记录膝关节屈伸度数。[结果]A组随访7⁴8个月(平均28个月),5例出现复发,Enneking下肢功能评估优11例(64.7%),良5例(29.4%),差1例(5.9%),优良率达94.1%;膝关节伸直0°,屈曲(131.5±17.8)°。B组随访848个月(平均28个月),5例出现复发,Enneking下肢功能评估优11例(64.7%),良5例(29.4%),差1例(5.9%),优良率达94.1%;膝关节伸直0°,屈曲(131.5±17.8)°。B组随访8⁴5个月(平均25个月),4例出现复发,Enneking下肢功能评估优11例(52.4%),良8例(38.1%),差2例(9.5%),优良率达90.5%;膝关节伸直0°,屈曲(116.5±15.4)°。组间比较,膝关节术后Enneking功能评估优良率差异无显著性(P>0.05),而膝关节屈曲度数可旋转稳定假体组较大,差异有显著性意义(P<0.05)。[结论]采用可旋转稳定型膝关节置换治疗胫骨近端恶性骨肿瘤是有效的保肢方法,可获得较单纯铰链型假体更大的膝关节活动度。     

旋转铰链型人工膝关节置换治疗膝部恶性骨肿瘤

[目的]探讨应用旋转铰链型人工膝关节置换治疗膝部恶性骨肿瘤的手术方法和疗效。[方法]应用旋转铰链型人工膝关节置换治疗膝部恶性骨肿瘤14例,其中股骨下端9例,胫骨上端5例。[结果]14例均获随访,时间17~65个月,平均44个月,总优良率为85.7%。膝关节活动度:伸0°,屈90°~130°,平均为110°。其中股骨假体置换后活动度平均120°,胫骨假体置换后活动度平均95°。术后肿瘤局部复发1例,假体松动1例,感染1例。[结论]旋转铰链型假体减少了骨与假体之间的应力,大大降低了松动或疲劳折断的发生率,是膝部恶性骨肿瘤较理想的保肢方法。     

个体化数字导板结合3D打印技术在旋转铰链型人工膝关节置换术中的应用

目的探讨个体化数字导板结合3D打印技术在旋转铰链型人工膝关节置换术中的应用。方法 2011年6月至2014年7月,采用旋转铰链型人工膝关节置换术治疗胫骨近端恶性骨肿瘤16例。术前行64排螺旋CT及3.0T MRI扫描,建立膝关节三维解剖模型并模拟手术及设计复位导板,应用熔融沉积成型技术制作实体导板,术中引导骨肿瘤截骨。结果所有患者均获随访,随访时间为5~44个月,平均31个月,总优良率为88.1%。膝关节活动度为伸膝0°、屈膝90°~125°(平均106°)。术后肿瘤局部复发4例,但无假体松动、感染等并发症发生。结论旋转铰链型人工膝关节可减少骨与假体之间的应力,降低假体松动及疲劳性骨折发生率,因此旋转铰链型膝关节置换术是膝部恶性骨肿瘤较理想的保肢方法。而应用个体化数字导板可减少手术操作时间,提高假体安装精度,从而达到更佳的手术效果。     

人工假体在膝关节周围骨肿瘤保肢治疗中的应用

目的：探讨对膝关节周围骨肿瘤切除后，采用人工全膝关节置换达到保肢的疗效。方法：1996—2000年共收治骨肿瘤患者11例，年龄18～55岁，其中恶性骨巨细胞瘤6例，骨肉瘤2例，软骨肉瘤2例，纤维肉瘤1例。股骨下端病变7例，胫骨上端病变4例。肢体功能重建方法为特制的人工全膝关节置换术。结果：本组11例经3～6年随访，8例无瘤存活，3例带瘤存活。术后肢体功能按Enneking评分系统评分，平均为21．5分，总优良率72．7％，其中股骨远端肿瘤术后平均为22．3分，胫骨近端肿瘤术后平均为20．0分。结论：采用特制的人工全膝关节置换术，能有效治疗膝关节周围低度恶性或恶性骨肿瘤，达到良好保肢效果。     

上胫腓关节切除在胫骨近端骨肉瘤保肢中的应用

目的探讨上胫腓关节切除在胫骨近端骨肉瘤保肢中的应用。方法1995年8月-2004年1月11例累及上胫腓关节的胫骨近端骨肉瘤患者在新辅助化疗支持下行包括上胫腓关节的胫骨骨肿瘤整块切除、人工膝关节置换、腓肠肌瓣移位重建伸膝装置及修复软组织缺损。其中男性7例,女性4例,年龄14～23岁,平均18岁。Enneking分期均为ⅡB期。结果II例患者均获得随访,随访时间2～9年,平均59个月。因肺转移死亡3例,肺转移带瘤存活1例,局部复发1例行截肢术;伤口皮肤坏死1例,下肢深静脉血栓2例,腓总神经牵拉损伤2例。术后膝关节功能MSTS93评分55％～86％,平均为70％;膝关节活动度0°～120°,平均为85°,伸直延迟均在0°～20°。结论对累及上胫腓关节的胫骨近端骨肉瘤在新辅助化疗支持下积极行包括上胫腓关节的胫骨骨肉瘤整块切除、定制人工膝关节置换术,手术疗效满意,但应注意相关并发症的防治。     

人工关节假体复合大段同种异体骨移植重建肢体功能

目的 探讨采用复合人工关节假体大段同种异体骨移植的方法治疗肢体恶性骨肿瘤的手术原理及效果。方法 骨肿瘤患者１６例,年龄１９岁－６０岁,其中骨肉瘤４例,软骨肉瘤２例,恶性骨巨细胞瘤３例,纤维肉瘤３例,其它恶性骨肿瘤４例,肢体功能重建方法包括：复合股骨近端的全髋关节置换术３例,复合股骨近端的双极人工股骨头置换术７例,复合股骨下端或胫骨上端的全膝关节置换６例,结果 本组１６例经１．５－５．０年随访,１例     

肿瘤型假体重建膝关节周围原发性肿瘤切除后骨缺损

目的总结膝关节周围原发性骨肿瘤保肢手术中人工关节重建的疗效和并发症。方法回顾性分析我院1995年12月至2005年12月83例应用肿瘤型假体重建膝关节周围骨肿瘤切除后骨缺损的临床资料。其中骨肉瘤58例,多中心骨肉瘤2例,皮质旁骨肉瘤1例,恶性纤维组织细胞瘤4例,骨巨细胞瘤13例,平滑肌肉瘤1例,尤文肉瘤2例,软骨肉瘤2例。根据骨缺损重建部位分组：股骨下端组44例,胫骨上端组34例,全股骨置换组5例。结果所有患者均获得随访,随访时间12～130个月,平均41个月。局部复发6例,2例晚期感染,假体松动2例,无假体断裂;假体3、5年生存率分别为88．2％、82．1％。41例植骨患者形成皮质外骨桥。肢体肌肉骨骼肿瘤外科治疗重建术后功能评分：股骨下端组19．0—29．0分,平均25．0分;胫骨上端组17．0—28．0分,平均24．4分;全股骨置换组16．0—21．0分,平均19．0分。股骨下端组和胫骨上端组功能优于全股骨置换。结论肿瘤型人工关节重建膝关节周围骨肿瘤并发症发生率低,关节功能良好。     

微波原位灭活联合人工关节假体置换治疗四肢恶性骨肿瘤的疗效分析

 目的 探讨微波原位灭活联合人工假体置换术治疗四肢恶性骨肿瘤（侵袭范围超过骨全长2/3）的可行性。方法 2001年6月至2012年4月对19例侵袭范围超过骨全长2/3的原发恶性骨肿瘤及转移瘤患者采用微波灭活联合假体置换术进行治疗。男12例, 女7例;年龄11~65岁, 平均47岁。原发恶性骨肿瘤11例,转移瘤8例。股骨远端8例、胫骨近端6例、肱骨近端3例、股骨近端2例。术前X线、CT显示骨干皮质破坏小于骨全长的1/3,而MRI显示肿瘤侵袭范围超过骨全长2/3。依据MRI确定截骨范围,定制肿瘤型人工假体。采用常规肿瘤假体置换入路,按广泛切除原则充分显露瘤段骨及软组织肿块。使用铜网保护瘤段骨周围软组织,用2 450 MHz微波将瘤段骨内部加热到50 ℃,持续20 min,按术前测量长度进行截骨,人工关节假体重建,逐层缝合组织及皮肤。结果 手术时间平均100 min,术中失血量平均600 ml。随访10个月~5年,平均2.7年。原发恶性骨肿瘤患者中1例术后出现复发,带瘤生存;2例术后其他部位转移,死亡;余8例随访期间未出现复发或转移。6例转移瘤患者分别于术后5~20个月出现其他部位转移,死亡;2例随访期间未出现原位复发或转移。3例肱骨近端肿瘤患者术后肩关节外展、上举功能受限,其余患者无关节功能受限。结论 微波灭活联合人工假体置换术治疗髓腔内广泛受累的四肢恶性骨肿瘤,能最大限度地保留术后患者的肢体功能。     

Prosthetic reconstruction for tumors of the distal tibia. Report of two cases

Prosthetic reconstruction in two patients with malignant bone tumors of the distal tibia was conducted. The diagnoses were metastatic bone tumor in one patient and low grade central osteosarcoma in another. The mean duration of follow-up was 5.5 years (3 and 8 years). Reconstruction was achieved using custom-made prosthesis (JMM, Japan Medical Materials), which replaced the distal tibia. In the patient with metastasis, local recurrence occurred 8 months after the primary surgery and the recurrent tumor was resected. Both patients were free from neoplastic disease at the latest follow-up. The average functional scores according to the system of the Musculoskeletal Tumor Society were 25 and 23. Custom-made prostheses allow an early return to functional weight-bearing without major complications. This technique provides a safe and effective method of stabilization for properly selected malignant tumors of the distal tibia.     

Long‐term outcome of giant cell tumors of bone around the knee treated by en bloc resection of tumor and reconstruction with prosthesis

Objective: To study the long‐term outcomes and complications of giant cell tumors around the knee treated with en bloc resection and reconstruction with prosthesis. Methods: From January 1991 to March 2005, 19 patients (11 men, 8 women, average age 35.4 years) were treated in our hospital with en bloc resection and reconstruction with domestic prosthesis (15 hinge knee and 4 rotating‐hinge knee). The distal femur was involved in 12 and the proximal tibia in 7 cases. Nine tumors were primary and 10 recurrent. All cases were Campanacci grade III. The affected limb functions were evaluated by the Musculoskeletal Tumor Society scoring system. Results: All patients underwent operation successfully with no complications. The mean follow‐up time was 128.9 months (60 to 216 months). Apart from one patient who underwent amputation because of wound infection two years after reoperation, the range of knee motion of 18 patients was 30°–110°. The mean functional score of the affected limb was 22.7 (15 to 27 points). The length of the lower extremities was equal in nine cases; the affected limb was 2–9 cm shorter in the other ten cases. Prosthesis fracture and loosening developed in one, prosthesis aseptic loosening in three, and delayed deep infection and prosthesis loosening in two cases. The prosthesis loosening rate was 31.6%. One patient developed a proximal femur fracture. Conclusion: En bloc resection and reconstruction with prosthesis is a feasible method for treating giant cell tumor of bone around the knee. Complications related to the prosthesis, mainly prosthesis loosening and limb shortening, increase gradually with longer survival time.     

定制人工假体置换治疗骨肿瘤的临床分析

目的：对应用定制肿瘤型人工假体置换治疗恶性骨肿瘤的临床疗效进行分析。方法回顾性分析我科2009年5月-2013年2月收治的恶性骨肿瘤患者29例,男18例,女11例;年龄17-65岁,平均38.5岁,股骨上端5例,股骨远端14例,胫骨上端7例,股骨下端3例。所有患者均接受对肿瘤进行广泛切除或根治性切除,包括综合性治疗及定制型人工假体置换治疗,术后对患者进行定期随访,对治疗效果进行评价。结果置换后1年采用MSTS保肢评分系统对随访患者进行功能评价,显示股骨远端患者（15.5-28.0）分,平均23.5分;股骨上端0.5-29.0分,平均23.5分;胫骨近端10.5-29.0分,平均22.4分。其中优9例,良15例,中4例,差1例,优良率为82.7%。术后并发症发生率为10.0%。1例患者于术后7个月死亡,1例患者于术后18个月后肺转移死亡,1例在术后13个月时出现局部复发现象而截肢,1例在术后8个月时出现局部复发单纯行瘤体切除。在随访时,所有患者均未出现人工假体断裂、松动现象。结论在骨肿瘤患者采用人工假体置换术前、术后给予综合性治疗,在对肢体功能加以保留,与其他重建方法相比,具有肢体早期负重、功能恢复快、使用期长的优点,患者生活质量大幅提高,是骨肿瘤保肢治疗的较理想选择,值得在临床中推广。     

累及腓骨的胫骨近端恶性肿瘤的保肢治疗

 目的 回顾性分析累及腓骨的胫骨近端恶性肿瘤患者病历资料,探讨其保肢技术,总结肿瘤学结果、并发症及功能情况。方法 自1998年11月至2010年2月,共有32例胫骨近端恶性肿瘤累及腓骨的患者接受保肢治疗,男21例,女11例;年龄10~66岁,平均23.4岁。骨肉瘤23例,软骨肉瘤5例,恶性骨巨细胞瘤1例,软组织肉瘤3例。全部病例接受包括腓骨上段在内的肿瘤整块切除,术中结扎并切断胫前血管14例,修补胫后血管1例,结扎并切断胫前血管并修补胫后血管2例、置换3例。切除腓总神经4例,腓深神经5例。采用关节假体置换24例,瘤段骨灭活再植假体复合置换5例,瘤段骨灭活再植3例。软组织覆盖采用腓肠肌内侧头肌瓣转移14例、外侧头肌瓣转移1例。结果 随访时间11~159个月,平均39.4个月。6例(18.8%)患者出现肿瘤局部复发。患者总体5年生存率 51.2%,14例死于肿瘤转移、2例带瘤生存、16例无瘤生存。15例(46.9%)发生各种并发症22例次,术后血管危象致患肢缺血4例,腓总神经麻痹12例,伤口表浅感染或积液4例,深部感染1例,假体周围骨折1例。国际骨肿瘤协会(Musculoskeletal Tumor Society, MSTS 93)评分平均21.6分(72%)。结论 胫骨近端恶性肿瘤累及上胫腓关节或腓骨时,应严格掌握适应证、仔细操作,以期获得足够的外科边界。尽管有一定的并发症发生,但是多数患者可以获得较好的术后功能。     

Kotz modular femur and tibia replacement: 28 tumor cases followed for 3 (1-8) years

In the period 1984-1991, 33 lower limb reconstructions were performed with an uncemented Kotz modular femur tibia reconstruction (KMFTR) prosthesis after resection of 32 malignant bone tumors and 1 benign giant cell tumor. Tumor localization was proximal femur in 12, distal femur in 17, and proximal tibia in 4. The mean age of the patients was 38 years. 28 patients with a minimum follow-up of 1 year were studied after 3 (1-8) years. 7 patients were reoperated because of complications. Good or excellent results were obtained in 6 of the 10 proximal and 13 of the 14 distal femur reconstructions. In 2 of the 4 patients undergoing combined distal femur and proximal tibia resection, a deep infection developed, and above-knee amputation was performed. One local recurrence occurred after proximal femur resection.     

半关节置换术在小儿胫骨上段恶性骨肿瘤中的应用

目的探讨半关节置换术用于儿童膝关节恶性骨肿瘤,以保留膝关节或重建膝关节的疗效。方法2000年3月~2005年6月对5例胫骨上段骨肉瘤患儿行半膝关节假体置换,年龄8~12岁。均经病理确诊为胫骨上段骨肉瘤,Enneking分期为B期以下。病变范围9~11cm,术前均行穿刺活检和正规化疗,并根据X线片、CT、MRI等影像学结果确定病变范围,测量和设计假体大小,假体长度略长于截骨段1~2cm。术后4周在支具保护下行走,并行2个疗程新辅助化疗。结果5例患儿均成功进行了半膝关节假体置换,术后4周膝关节活动度分别为伸170~180°,屈90~120°。术后除1例局部皮肤坏死,经皮瓣移位修复伤口期愈合外,余患儿伤口均期愈合。随访24~36个月,1例于术后8个月因肿瘤肺转移死亡,余均无肿瘤转移和复发,均能进行日常生活和学习。结论半膝关节置换用于儿童膝关节周围恶性肿瘤,具有保留正常骨骺及膝关节和重建膝关节优点,同时达到保肢手术的目的,为成年后全膝关节置换创造了条件。     

Limb salvage and prosthetic joint reconstruction for low-grade and selected high-grade sarcomas of bone after wide resection and replacement by autoclaved [corrected] autogeneic grafts

Wide resection is an acceptable alternative to amputation for the management of primary sarcomas of the long bones or pelvis. The resected bone can be debrided of gross tumor tissue, autoclaved, and then replaced over intramedullary fixation to reconstruct the limb anatomically. The procedure can be combined with prosthetic reconstruction of adjacent joints with sufficient strength to allow early unprotected weight-bearing. Resection and replacement for 28 low-grade (G1) and 14 selected high-grade (G2) sarcomas were performed in 42 patients. The hemipelvis was resected and replaced four times, the proximal or distal femur 28 times, the proximal or distal tibia eight times, and the proximal humerus two times. Replacement of an adjacent joint, most commonly using a long-stemmed hip or knee prosthesis, was accomplished in 33 patients. All patients had been followed for a minimum of two years, nine months after treatment. The mean follow-up period is four years, ten months. Six individuals, all with high-grade sarcomas, developed tumor-related complications. Two evidenced a local recurrence of tumor, and four developed distant metastases. None of the patients with low-grade sarcomas developed a recurrence or metastases. Fifteen patients suffered complications unrelated to tumor control; 13 required reoperation, including two who required amputations for persistent pseudoarthrosis and graft infection, respectively. There was one other infection, successfully eradicated by drainage followed by local and systemic antibiotics. Due to mechanical failure or loosening, six patients were treated by successful revision of their joint arthroplasties. Two years after initial surgery, five patients had failures of union at the graft-host junction. Four healed after cancellous grafting and one was revised to a custom prosthesis. There were no late fatigue fractures of the grafts. The technique does not compromise the margins for adequate tumor resection. It preserves a graft strong enough to support a joint arthroplasty and to allow early weight-bearing with a low risk of pseudarthrosis or late fatigue fracture.     

Hip rotationplasty for malignant tumors of the proximal part of the femur

Disarticulation of the hip and hemipelvectomy have been the only surgical alternatives available for the adequate local control of malignant tumors of the proximal part of the femur in patients who are still growing. The use of proximal or total femoral implants is restricted to patients who have reached skeletal maturity. To improve the quality of survival for patients who have not yet reached skeletal maturity and have a malignant tumor of the proximal part of the femur, I have modified the rotationplasty procedure described by Van Nes for use in such lesions. After en bloc resection of the tumor, the distal part of the femur with the knee joint and leg is rotated 180 degrees and fixed to the lateral side of the pelvis. The knee joint then functions as a hinge hip joint and the ankle joint functions as a knee joint. This procedure was performed in eight patients, three of whom were followed for more than two years. All patients walked well with a prosthesis and the functional results were excellent. At the time of writing, there had been no recurrence of a tumor or pulmonary metastasis.     

Malignant transformation of a giant cell tumor 25 years after initial treatment

The current authors report a patient in whom a malignant fibrous histiocytoma developed long after a benign giant cell tumor of bone was removed from the same site. Twenty-five years after a benign giant cell tumor of the lateral condyle of the proximal tibia had been treated by curettage and iliac bone grafting without radiotherapy, a 53-year-old woman noted progressive pain and an enlarging mass in the same area. Radiographs showed osteolytic change, whereas magnetic resonance imaging indicated a tumor arising at the site of the giant cell tumor and extending beyond the bone. Examination of an open biopsy specimen showed a high-grade malignant fibrous histiocytoma with some areas rich in giant cells. After five courses of caffeine assisted intraarterial chemotherapy, the tumor was resected with an adequate margin, and the defect was reconstructed with an implanted prosthesis of corresponding shape. The extensor mechanism of the knee was reinforced using an allograft of fascia from the tensor fascia lata muscle. The resected specimen showed a good histologic response (95% tumor necrosis) to preoperative chemotherapy. Excellent function in the knee has been regained with no evidence of disease recurrence. Caffeine potentiated chemotherapy was effective in minimizing the extent of tumor excision, in this case of high-grade malignant fibrous histiocytoma representing transformation from a benign giant cell tumor.     

The long-term results of endoprosthetic replacement of the proximal tibia for bone tumours

We have investigated whether improvements in design have altered the outcome for patients undergoing endoprosthetic replacement of the proximal tibia following resection of a tumour. Survival of the implant and 'servicing' procedures have been documented using a prospective database. A total of 194 patients underwent a proximal tibial replacement, with 95 having a fixed-hinge design and 99 a rotating-hinge with a hydroxyapatite collar; their median age was 21.5 years (10 to 74). At a mean follow-up of 14.7 years (5 to 29), 115 patients remain alive. The risk of revision for any reason in the fixed-hinge group was 32% at five years, 61% at ten years and 75% at 15 and 20 years, and in the rotating-hinge group 12% at five years, 25% at ten years and 30% at 15 years. Aseptic loosening was the most common reason for revision in the fixed-hinge knees, fracture of the implant in the early design of rotating hinges and infection in the current version. The risk of revision for aseptic loosening in the fixed-hinge knees was 46% at ten years. This was reduced to 3% in the rotating-hinge knee with a hydroxyapatite collar. The cemented, rotating hinge design currently offers the best chance of long-term survival of the prosthesis.