The Journal of Bone and Joint Surgery, Vol 68, Issue 4 579-585, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
Evaluation of the Noiles hinged knee prosthesis. A five-year study of seventeen knees
R Shindell, R Neumann, JF Connolly and OM Jardon
The Noiles hinged knee prosthesis has been reported to diminish sheer and
tensile loading on the cement-bone interface. Theoretically, this should
eliminate the complication of loosening, commonly reported in hinged total
knee prostheses. We reviewed the cases of all of the patients who have been
treated with the Noiles knee prosthesis at our institution. Eighteen knees
in fourteen patients were available, seventeen of which were followed for
more than five years. Although all of the prostheses did well initially,
ten knees in eight patients (56 per cent) had failed by an average of
thirty-two months postoperatively. These eight patients included four of
the five who weighed more than ninety kilograms and all of those who had
had a prior arthroplasty. The failures were clearly defined along the lines
of sex distribution. Measurements on the radiographs showed a significant
difference between sexes in the metaphyseal diameter and thus in the
percentage of the femoral canal that was filled by the prosthesis and
cement. We concluded that prosthetic design must incorporate cortical
cement support to reduce stress at the cement-bone interface, especially in
a medullary canal with a larger diameter.
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