The Differences of Fixation Method in Proximal Chevron Osteotomy for Hallux Valgus: K-Wire, Cannulated Screw, Plate / 대한족부족관절학회지

PURPOSE: The authors evaluated the differences between K-wires and Cannulated screw, plate for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. MATERIALS AND METHODS: There were 62 patients (79 feet) who were moderate and severe degree hallux valgus according to the classification of Mann. They all got the proximal chevron osteotomy when correcting the deformity. We divided the patients into 4 groups, Two K-wire fixed group as A, one cannulated screw fixed group as B. Two cannulated screw fixed group as C, Plate fixed group as D, Group A were patients (26 feet) and Group B were patients (9 feet), Group C were patients (31 feet) and Group D were patients (13 feet). Preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patient. ANOVA test and Student t-test were done for statistical analysis. RESULTS: Mean follow up period was 43.8 months (range: 12~82 months). Preoperative mean IMA was 16.4+/-3.5, 17.7+/-11.3, 17.3+/-5.9 and 16.6+/-2.3 degrees in respectively group A, B, C, D. Immediate postoperative mean IMA was 5.6+/-3.4, 7.3+/-4.4, 7.6+/-4.4 and 6.7+/-2.8 degrees in respectively group A, B, C, D. The final mean IMA was 8.9+/-4.5, 15.2+/-7.5, 10.3+/-4.4 and D 7.7+/-3.5 degrees in respectively group A, B, C, D. There were significant statistical increase in final mean IMA of group B and C (p<0.05). CONCLUSION: The IMA was significantly increased in the group which used one or two cannulated screw for fixation on follow up, therefore more caution should be needed when using one or two cannulated screw fixation technique after proximal chevron osteotomy.

Clinical Analysis and Results after the Amputations of Lower Extremities due to Diabetic Foot / 대한족부족관절학회지

PURPOSE: The authors evaluated the clinical results and prognosis after amputating the lower extremity due to diabetic foot. MATERIALS AND METHODS:From 1991 to 2003, the patients who had suffered amputation of his lower extremity due to diabetic foot ulcer were evaluated retrospectively. 79 patients were male and 6 patients were female. The author evaluated the patient who had the ipsilateral additional surgery, contralateral amputation, level of blood sugar, combined disease and mortality rate within 5 years from medical record. Statistical analysis was done by Chi-square test and Kaplan-Meier survival test. RESULTS:Mean age of patients who had first experienced amputation was 63.4 years old. The mean duration of diabetes until amputation was 14.5+/-7.5 years. Major amputations were 50 cases and minor amputations 35 cases. 20 patients (23.5%) were suffered ipsilateral secondary surgery including revised stump. Overall 5-year mortality rate was 18.8% (16 cases). Death rate within 1 year was 8.2% (7 cases), mortality rate within 3 years was 14.1% (12 cases). 5-year mortality rate after major amputation was 20% (10 cases) and after minor amputation was 17.1% (6 cases). It was statistically significant (p<0.05). Patient who underwent more than 2 combined vascular related disease had higher mortality rate than diabetic amputee without combined disease (p<0.05). CONCLUSION: Mortality rate after major amputation was significant higher than amputation after minor amputation in diabetic patients from our data.

The Differences between Fixation Devices for Proximal Chevron Osteotomy in Hallux Valgus Surgery / 대한족부족관절학회지

PURPOSE: The authors evaluated the differences between K-wires and Bold screw for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. MATERIALS AND METHODS: There were 59 patients (81 feet) who were moderate and severe degree hallux valgus according to the classification of Mann. They all got the proximal chevron osteotomy when correcting the deformity. All patients were followed up at least 6 months. We divided the patients into 2 groups, K-wires fixed group as A, Bold screw fixed group as B. Group A were 42 patients (63 feet) and Group B were 18 patients (19 feet). Among the Group B, 2 feet who were failed to fix the oetotomy site with Bold screw, were fixed with K-wires during operation. We measured the AOFAS score preoperatively, postoperatively and at final follow-up, VAS score at 2 weeks after the operation. Also preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patients. RESULTS: Mean follow up period was 1.34 year (range: 6 months-6.16 years). Mean VAS score of group A was 3.21+/-1.7 and group B 1.76+/-1.0. Preoperative mean AOFAS score of group A was 45.61+/-8.3, group B 44.41+/-8.9, the final mean score of group A was 88.87+/-8.3 and group B 92.47+/-4.4. Preoperative mean HVA was 30.82+/-6.6 degrees in group A and 32.88+/-14.5 degrees in group B, the final mean angle of group A was 14.89+/-8.3 degrees and group B 17+/-4.4 degrees. The preoperative mean IMA of group A was 13.69+/-3.6 degrees and group B 12.35+/-5.2, the final mean angle of group A was 9.26+/-3.6 degrees and group B 12.35+/-5.8 degrees. CONCLUSION: There were no statistical differences in radiologic and clinical results (p>0.05) but, group B exceeded group A in VAS score (p=0.0007) and had no statistical significance in terms of reduction angle loss (p=0.06). Early returning to normal life activity may be possible for patients using Bold screws.

Bilateral Elastofibroma Dorsi of the Shoulder: Case Report

We report a case of an 86-year-old man diagnosed with bilateral elastofibroma dorsi who was managed conservatively after a two year follow-up. An elastofibroma dorsi is a benign, slow-growing tumor that is most often located in the inferior periscapular area in elderly patients. It should be considered to differentiate them from other soft tissue tumors located at the inferior periscapular region. Increased awareness of these characteristics will decrease the incidence of a misdiagnosis of elastofibroma dorsi as a malignancy and avoid unnecessary surgery.

Quantitative Analysis of the Patellar Tap Test for Knee Joint Effusion

PURPOSE: The purpose of this study was to detect the amount of the saline which was injected into a knee joint and made the patella ballottable. MATERIALS AND METHODS: From January 2002 to June 2003, into 37 knees, saline was instilled through a needle inserted at 2 cm distant form superolateral aspect of the patella. The patellar ballottement was examined after every 1 cc injection of the saline. We checked the amount of the injected saline when the ballottement of the patella was developed and when ballottement was disappeared by milking fluid distally from suprapatellar pouch.my. RESULTS: The patella tap test was positive when the amount of instilled saline was between 14 cc and 45cc, and the pattern of distribution was biphasic. A patella tap disappeared if more than 39~110 cc of fluid was injected, which showed triphasic pattern of the distribution. CONCLUSION: The amount of knee effusion between 14~110 cc got the patella ballottable. And the pattern of distribution was variable. Therefore we need more numbers of data to analyze the differences.

The Operative Treatment of Mid-Shaft Clavicular Nonunions: Intramedullary Fixation with Threaded Steinmann Pin and Bone Grafting

PURPOSE: To evaluate the clinical and radiological results of the treatment of mid-shaft clavicular nonunions using intramedullary fixation with threaded Steinmann pin and bone grafting. MATERIAL AND METHODS: In 16 patients treated with intramedullary fixation of threaded Steinmann pin and autogenous iliac bone grafting for the mid-shaft clavicular nonunions, 10 patients with follow-up over 1 year were investigated. All patients (10 clavicle fractures) underwent conservative treatment initially. The average age of patients was 56 years old (range, 18~70 years old). Eight cases were atrophic nonunions, two hypertrophic. A clinical assessment was evaluated postoperatively after 5 months according to the evaluation method of Kona et al. RESULTS: According to the evaluation method of Kona et al, four cases achieved excellent results, five cases good, and one case achieved a fair result. The average period until bony union was 9 weeks (range, 7~12.5 weeks) without infection, pin migration or breakage. One case showed skin irritation by lateral margin of Steinmann pin, which was subsided by pin removal after bony union. CONCLUSION: We obtained satisfactory results and have concluded that intramedullary fixation with threaded Steinmann pin and bone grafting could appropriately treat nonunions of the mid-clavicular fracture occurred after conservative treatment, because it minimizes soft tissue injury, gets relatively stable fixation and early ROM, predicts early bone union, facilitates pin removal under local anesthesia.

Recurred Diffuse Pigmented Villonodular Synovitis of Ankle Joint: Case Report / 대한족부족관절학회지

Pigmented villonodular synovitis (PVNS) in ankle is relatively uncommon. This disorder results in increased proliferation of synovium causing villous or nodular changes containing histiocytes, fibroblasts, multinucleated giant cell, and hemosiderin. PVNS is classified into two different type : localized and diffuse. Diffuse type of PVNS in ankle is more common than localized type. Also, recurrence of diffuse type is more frequent. We report a case of diffuse type of PVNS which was recurred soon after the excision.

Arthroscopic Ankle Fusion Using Two Medial Cannulated Screws / 대한족부족관절학회지

PURPOSE: We evaluated the clinical and radiological results of arthroscopic ankle fusion using 2 medial screws which had advantages of less morbidity, early weight-bearing and high union rate. MATERIAL AND METHODS: From April, 2002 to March, 2004, 8 patients who had ankle osteoarthritis were treated by ankle fusion using 2 medial screws under arthroscopy; five patients with post-traumatic osteoarthritis, two with post-infectious arthritis and one with paralytic foot. There were 5 male and 3 female. Average age was 67 years old ranging from 57 to 71 years. We evaluated them clinically preoperative and postoperative using AOFAS score, VAS pain scale and patient's satisfaction. In regard to radiological fusion, we checked them by simple AP, lateral and mortise view. Follow up period was average 11 months (range, 6~24 months). RESULTS: All ankles were successfully fused with 2 medial screws under arthroscopy. The mean time of fusion was 10.5 weeks (range, 8~14 weeks). Patient's satisfaction checked at 6 months after operation had favorable results (excellent and good 75%). One case had pain on medial malleolar area because of screw's protrusion. CONCLUSION: Arthroscopic ankle fusion using 2 medial screws was good modality of ankle fusion with less morbidity and early weight-bearing in some cases of ankle arthritis.

Revision Total Hip Arthroplasty using Morselized Femoral Head Allograft and Cementless Cup in Acetabular Bone Deficiency / 대한정형외과학회잡지

PURPOSE: This study was aimed to evaluate the clinical and radiologic results of revision total hip arthroplasty using a cementless cup and a morselized femoral head allograft in acetabular bone deficiency. MATERIALS AND METHODS: From January 1992 to December 1999, the authors performed 37 revision total hip arthroplasties using morselized femoral head allografts and cementless cup. This study evaluated the clinical and radiologic results, at a mean follow-up of 50 months. We evaluated the Harris hip score clinically, and the displacement of acetabular cup by Yoder's criteria. Location and progression of radiolucent area within acetabular zone, which was defined by DeLee and Charnley was observed and recorded. RESULTS: Mean Harris hip score was improved from 50.6 preoperative to 89.2 at final follow-up. A radiolucent zone between host bone and graft bone was observed in 5 cases, and between graft bone and cup in 7 cases, but all of these were less than 2 mm. The change of cup angle more than 4 degrees were observed in 3 cases in Gross type 4, 4 mm superior migration of acetabular cup was observed in 1 case in Gross type 3 and 5 mm horizontal migration was observed in 1 case in Gross type 4. CONCLUSION: Although the early results in revision total hip arthroplasty have been encouraging to date except for Gross type 4, a more long term follow-up study with a larger size cases are needed.

Treatment of Osteoporotic Vertebral Collapses of the Thoracolumbar Spine with Neurologic Deficits using Anterior Approach / 대한척추외과학회지

STUDY DESIGN: Retrospective OBJECTIVES: To evaluate the clinical and radiological results of treatment for thoracolumbar spine fractures, with neurological deficits, using an anterior approach in a senile osteoporotic spine. SUMMARY OF BACKGROUND DATA: With osteoporotic vertebral collapses, an operative treatment may be indicated for lesions that are considered unstable, especially if there is spinal canal compromise with neurological deficits. As for the treatment of these cases, a posterior approach destabilizes, and increases, the kyphotic deformity, resulting in the need for a longer fusion period. A combined anterior-posterior approach increases the morbidity. A one stage anterior decompression and anterior reconstructive stabilization is often the most reasonable operative choice. MATERIALS AND METHODS: Between January 1999 and August 2001, 12 cases of thoracolumbar osteoporotic vertebral collapse, with neurological deficits, were performed. There were 10 female and 2 male cases. The mean age for the patient was 69.3 years, ranging from 60 to 79 years. The numbers of each level of fractured vertebrae were; 2, 5, 4 and 1, in eleventh thoracic, twelfth thoracic, first lumbar and second lumbar vertebrae, respectively. All patients reported minor injury or trauma, and the average interval between injury and operation was 8.3 months, ranging from 1 to 36 months. There were 4 and 8 cases of neurological deficits in the Frankel D2 and D3 groups, respectively. The average preoperative local kyphotic angle was 23.8 degrees, ranging from 5 to 35 degrees, with a 66% loss in height, ranging from 42 to 83%). The average T score from the Bone Densitometry was -3.7 S.D, ranging from -3.2 to -4.4. The operations were performed by an extrapleural-retroperitoneal approach. The anterior instrumentation was performed with the Kaneda system and a titanium mesh cage. All cases were followed for more than 12 months. RESULTS: All cases had a solid bony fusion. The immediate postoperative average local kyphotic angle was 10.3 degrees, ranging from -14 to 22 degrees, and the correction loss at the last follow-up was 2.6 degrees, ranging from 0 to 9 degrees. All 12 patients with incomplete preoperative neurological deficits improved, postoperatively, to Frankel group E. CONCLUSIONS: The one stage anterior spinal decompression and reconstruction, with a Kaneda instrument and a titanium mesh cage, afforded enough stability in patient with an osteoporotic vertebral collapse to enable early ambulation and to achieve realignment and solid fusion, and seems to have merit in the neurological recovery following an operation.

Intraosseous Lipoma in Humerus: A Case Report / 대한정형외과학회잡지

Intraosseous lipomas are extremely rare and this incidence has been reported to be less than one per 1,000 primary bone tumors. Because of its rarity, information of this tumor is obtained from case reports. We report a case of intraosseous lipoma that developed in the proximal humerus. The patient was a 69-year-old male who had experienced night pain and intermittent pain at the proximal humerus for 10 years. Simple x-ray revealed a well demarcated osteolytic lesion, which was measured 4 cm in width with a central calcific lesion. There was no cortical destruction in the proximal humerus. He was treated by currettage without bone graft, thereafter his symptoms were relieved.

Three-level Anterior Cervical Discectomy and Fusion with Cervical Plate / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the clinical and radiological outcomes by the method of three-level anterior cervical discectomy and fusion with cervical plate. SUMMARY OF LITERATURE REVIEW: The arthrodesis rate and outcome for patients having three-level anterior cervical discectomy and fusion procedures is disappointing. The success of arthrodesis depends on several factors including bone graft type, size, and additional anterior plate fixation. MATERIALS AND METHODS: Five patients (average age, 69 years; all males) were observed. All had a anterior discectomy, placement of autogenous tricortical iliac bone graft at three-levels and application of a Orion plate. Clinical and radiologic results of bony union, cervical lordosis and intervertebral disc height were assessed. RESULTS: All clinical symptoms of patients had been resolved after operation. The postoperative scores by the criteria of Odom are 2 in excellent and 3 in good. The bony unions were achieved in all cases in the average 12 weeks after surgery (minimum 8 weeks, maximum 20 weeks). The sum of three-level intervertebral disc height in average was increased from 14.8 mm preoperatively to 25.4 mm postoperatively. The average angle of cervical lordosis was corrected from 18o preoperatively to 27o postoperatively. CONCLUSIONS: The three-level anterior cervical discectomy and fusion with Orion plate and autogenous tricortical iliac bone graft results in effective surgical treatment, which produces good clinical outcome, early and solid bony union, restoration of the normal cervical lordosis and disc space height.

Reconstruction of Lumbar Kyphosis with circumferential Fusion by Posterior-Anterior-Posterior Approach / 대한척추외과학회지

STUDY DESIGN: Six patients with the lumbar kyphosis who underwent the circumferential fusion by posterior-anterior-posterior method were reviewed retrospectively from January 1998 to June 1999. OBJECTIVES: To determine whether patients with lumbar kyphosis can be successfully treated by circumferential fusion by posterior-anterior-posterior method. SUMMARY OF LITERATURE REVIEW: In the lumbar kyphosis, many procedures have been reported to correct the deformity, including multiple osteotomy, transpedicular vertebral resection, posterior interbody fusion, etc. Circumferential fusion by posterior-anterior-posterior method is suggested in this report as a valuable technique for excellent deformity correction and maintenance. MATERIAL AND METHODS: The surgery consists of posterior structural release with decompression followed by anterior structural release with interbody fusion by use of bone graft and posterior fixation. Clinical and radiologic results of the lumbar lordosis, sacral inclination and C7 plumb-line were assessed. RESULT: The mean segments of anterior and posterior fusion were 2.8 and 3.5 respectively. All clinical symptoms of patients had been improved in more than good. The average angle of lumbar lordosis was corrected from kyphosis 2.8degree preoperatively to lordosis 31.2degree postoperatively. At the last follow-up, the average loss of correction was 2.3degree . The average angle of sacral inclination was corrected from 6.7degree to 50.8degree . The distance from supero-posterior corner of S1 to C7 plumb line was reduced from 11.0 cm to 2.75 cm. CONCLUSION: The circumferential fusion by posterior-anterior-posterior method offer an effective surgical treatment, which produce excellent deformity correction, fusion rate, maintenance of the correction and good clinical outcome.

Late Infection of Spinal Instrumentation / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of five cases of late spinal infection after spinal instrumentation and fusion. OBJECTIVES: These cases are reviewed to verify risk factors for late spinal infection after elective instrumentation and to manifest the treatment of this complication. SUMMARY OF LITERATURE REVIEW: Late spinal infection after elective spinal instrumentation and fusion are uncommon. The diagnosis is usually hard and requires much clinical suspicion. MATERIALS AND METHODS: 5 cases were in total 374 patients of the author's cases. These cases are reviewed retrospectively. RESULTS: All patients reported aggravated back pain. 4 patients had elevated erythrocyte sedimentation rates, averaging 44.8 mm/hour and elevated C-reactive protein, averaging 26.2mg/L. No distance foci of infection was identified. All patients got the radiolucent zone around screw fixation site, averaging 4.6mmwidth. The organisms were S. epidermidis in 1 case and coagulase(-) staphylococcus in 1 case. All cases were treated by operative method with debridement, instrument removal with or without revision and postoperative intravenous antibiotics. The average follow-up period was 18.2 months, one patient recurred back pain at 7 months after operation. CONCLUSION: The diagnosis of late infection after elective spinal instrumentation and fusion requires high suspicion of clinical symptoms and signs. All except one were successfully treated by operative treatment.

Septic Hip in a Child due to H.influenzae: Problems with a Recent Experience / 대한정형외과학회잡지

We report a case of acute septic arthritis of the hip in a child due to H. influenzae with review of the problems encountered. A one year and 9 months-old male child was admitted because of fever, limping and restlessness of 48-hour duration. Under the impression of septic arthritis of the right hip, blind broad-spectrum antibiotic regimen was initially instituted. Fever subsided immediately and two blood cultures yielded no growth, as did joint tapping. But fever recurred on the 8th day of admission. MRI demonstrated fluid collection in the right hip. Arthrotomy yielded thin pus. The antibiotic regimen was shifted to vancomycin, according to the culture report of S. aureus. However, spiking fever continued. On the 4th week of admission, recheck MRI demonstrated fluid collection in and out of the hip joint. A second arthrotomy yielded frank pus. H. influenzae was reported in pus culture for the first time, being susceptive only to chloramphenicol. Fever was down to normal temperature after injection of urfamycin. Radiograph on the 17th day after the 2nd arthrotomy revealed posterior dislocation of the right hip. MRI demonstrated granulation tissue within the acetabulum. Open reduction confirmed granulation tissue without pus. This case suggests: 1. Routine blind antibiotic regimen for gram-positive and negative organisms in the initial phase of treatment may fail in the rare case of H. influenzae. This may lead the surgeon to miss the optimum time of surgical intervention despite early diagnosis, 2. Arthrotomy may fail if not followed by antibiotics sensitive to the pathogen. 3. Delayed pathologic dislocation may ensue due to invasion of granulation tissue.

Total Hip Arthroplasty for Fused Hips / 대한정형외과학회잡지

The conversion of the fused hip to THA may be used for patients with painful pseudoarthrosis, and malposition of the arthrodesed hip. It may also be used for patients with disabling pain in the ipsilateral knee, contralateral hip or lower back. Nineteen fused hips have been converted to total hip arthroplasty from January 1985 to December 1993. They were followed up for an average of 6 years. The causes of the fused hip were post-traumatic osteoarthritis (8 cases), tuberculous arthritis (6 cases), ankylosing spondylitis (3 cases) and rheumatoid arthritis (2 cases). The results of THA were satisfactory in all cases. The average Harris hip score after THA was improved from 56 to 84.1. The results of THA were best in patients with tuberculous arthritis and poorest in patients with ankylosing spondylitis. The average range of motion after THA is as follows: flexion 82 degree, abduction 28 degree, adduction 16 degree, external rotation 27 degree and internal rotation 13 degree. The average leg length discrepancy improved from 3 cm to 1.5 cm. The conversion of the fused hip to THA improves the patient s quality of life, so it is a useful treatment for the fused hip.

Fracture of the Ipsilateral Femur after Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: Although considered uncommon, periprosthetic fracture of the femur after hip arthroplasty is a serious complication that can be difficult to treat. Authors analyzed the types of fracture and modality of treatment. MATERIALS AND METHODS: Between Jan. 1983 and Dec. 1997, 17 cases of postoperative periprosthetic fractures had been treated at our hospital. These cases were followed up for an average of 58 (13-123) months. The fractures were classified according to Duncan and Masri classification. Three cases of type A, and 6 cases of type B1, 3 cases of type B2, 3 cases of type B3 and 2 cases of type C. The 3 cases of type A and 2 cases oftype B1 were conservative treatments. The 4 cases of type B1 were treated with open reduction and internal fixation with bone graft. The 3 cases of type B2 and 3 cases in type B3 were treated with long stem revision. The 2 cases of type C were treated with open reduction and internal fixation with bone graft. RESULTS: Bony union happened in all cases. The results according to Beals and Tower criteria were excellent in 12 cases, good in 3 cases and poor in 2 cases. CONCLUSIONS: The most frequent cause of periprostic fracture was trauma and other causes were loosening and osteolysis. Proper treatment method of periprosthetic fracture were important for stability of femoral stem

Two-Stage Reimplantation for the Treatment of Infected Total Knee Arthroplasty / 대한정형외과학회잡지

Deep infection following arthroplasty of the knee is a serious complication resulting in pain, discharge and loss of function. The incidence of deep infection ranges from 1% to 2% in a majority of reported series. There are several options for treatment of infected total knee arthroplasty: (1) antibiotic suppression, (2) debridement, (3) resection arthroplasty, (4) reimplantation, (5) arthrodesis, (6) amputation. Among them, recent reports have favored a two-staged regimen exchanging the prosthesis in an infected knee by using an antibiotic impregnated cement spacer. The result of our study support this option for treatment. We have experienced 14 cases of two-staged reimplantation in infected total knee arthroplasty, diagnosed according to the criteria described by Bengstons and followed up for more than two years. The average interval from prosthesis removal to revision was 6.85 weeks. Prior to revision, the average knee score was 50 points, and the average range of motion was 74 degree. After revision, the average knee score was 81 points. The average range of motion was 95 degree. Our protocol for the treatment successfully eradicated the deep infection in 13 patients, only a patients who had severe rheumatoid arthritis was the sole documented case of reinfection.

Eosinophilic Granuloma of Lumbar Spine in Old Patient: 1 Case Report / 대한척추외과학회지

Eosinophilic granuloma of bone is a self-limited condition, characteristically a disease of children and young adults. It is the most benign variant of histiocytosis X. It is most common in skull, but any bone may be affected. Vertebral involvement occurs in about 10 to 15%. This benign bone destructive lesion is characterized by the presence of Langerhans cells contain Birbeck granules, infilitration of histiocytes and eosinophilic leukocytes unknown origin. We report a eosinophilic granuloma in lumbar spine of old patient.

The Rotating Total Knee Arthroplasty: 67 Cases Reports

Total knee arthroplasty of Sledge type is difficult to perform successfully in severely damaged knee that has poor bone-stock and ligament instability. High rate of loosening has be.en found in total hinge type and kinematic rotating hinge type, so we considered use of tibia rotating prosthe,,is that allows motion with stability would be a good option. The indications of this type are severe varus deformity, bone loss, incompetent ligament, or revision. We studied 67 cases of total knee arthroplasty using Endo Model rotating total knee arthroplasty (WALDEMAR LINK GmbH & Co. Germany), which had been performed from January, 1991 to June, 1994. Thirty knees out of 67 cases were degenerative osteoarthritis, 15 posttraumatic arthritis, 11 rheumatoid arthritis, 5 revision arthroplasty, 2 sequelae of pyogenic arthritis, etc. Thirteen knees out of 67 cases had patellar resurfacement. Twenty-six out of 67 cases had bone graft. Using the Knee Rating Score of Hospital for Special Surgery, 3S were excellent and 2 l good.