Marked bone loss and severe instability require the insertion of a prosthesis with a fixed hinge.
The lack of rotation of these replacement joints places severe shear stress on the femur and tibia. For this reason they are liable to loosen or erode surrounding bone.
Constrained prostheses are mainly used following wide resection of bone for cancer surgery e.g. osteosarcoma around the knee.
Revision of these knee replacements is difficult because of the amount of bone loss.
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