SummaryIntroduction.Total knee replacement (TKR) is still a challenging procedure for severe gonarthrosis patients. Deformities of knee joint (varus, valgus - more than 30 degrees), insufficiency of collateral ligaments and extensive bone loss could be a difficult problem to solve with standard knee endoprosthesis. Also in cases of revision - TKR the restoration of bone loss and regaining of stability of the joint could be a problem.Aim of the Study.The aim of our study was to analyse the results with Rotating - Hinge prosthesis after severe primary and revision TKR.Materials and Methods.34 patients (27 female, 7 male) were treated with Rotating - Hinge prosthesis during 12 years (first in 1997). Mean age of patients were 69 years. 17 operations were primary total knee arthroplasties and also 17 were revisions of the knee prosthesis. The Oxford Knee score was used for evaluation of patients satisfaction rate. The Knee Society Score was used to get objective functional results. For radiological analysis X-rays of knee joint in two projections were performed.Results.34 Oxford Knee score questionnaires were sent to patients, response we got from 27 patients (79%). Mean result from Oxford Knee score was 32 which is good. The same number of patients (34) were invited for examination using Knee Society score. The response were from 20 patients (59%). Mean result from Knee Society score was 83, which means excellent.Conclusions.Rotating-Hinge prosthesis allows to achieve good and excellent functional results and high patients satisfaction rate after severe primary and revision TKR. The biological age, general health condition, insufficiency of ligaments and previous infection in patients history have to be considered for choosing the tactics for each case.

167antibiotic (Gentamicin) for fixation of femoral and tibial metaphyseal parts. There was found Staphylococcus xylosus in the microbiological samples taken during operation. Despite that the wound healed primarily. Postoperatively the patient got parenteral antibiotics for 3 weeks and then oral antibiotics for 1 month. From 2004 pain and swelling appeared in the right knee. 8 years and 2 months after primary operation, the revision TKR was performed with similar implants as in the left knee (Johnson&Johnson TC3) (Fig. Nr.5,6). The allografting and bone cement with antibiotic (Gentamicin) were used. Both of removed implants were with massive polyethylene wear on the joint surfaces. From 2007 patient had complaints about pain, swelling and limitation of movements in the left knee again, but no microbes were found in the joint fluid sample before the operation. The re-revision operation of left knee joint was done with rotating-hinge endoprosthesis (Waldemar Link company´s Endo-model) (Fig. Nr.7,8) 11 years after primary TKR. Both femoral and tibial components (including stems) of endoprosthesis were fixed with antibiotic (Gentamicin) loaded bone cement. During operation no microbes from tissue samples were found. (Fig. Nr.11,12). Half a year after last operation patient had no pain and satisfactory range of movements (flexion 95 degrees, full extension) in both knees. Patient could walk without walking aids and any limp. DISCUSSIONTKR have had excellent results, with multiple studies showing survival rates greater than 90% at followup times of 10 to 20 years.1-6 Development of the knee replacement operations with different types of endoprosthesis still continues. Numerous prostheses have been developed to improve the durability and function of these procedures. However, there has been controversy regarding whether the posterior cruciate ligament (PCL) should be retained or removed during procedure. 8 SummaryWe report about the patient who underwent seven replacement operations in both knees during twelve years period. Different types of implants were used due to clinical situation and septic complications.