Early reports of hinge total knee arthroplasty showed high rates of complications and implant failure. Third-generation modular, mobile-bearing, hinge knee arthroplasty systems have evolved to decrease the deleterious stresses that contributed to the failures of earlier designs. The combined series of Barrack et al and Jones et al documents midterm results using the S-ROM Hinge Knee System for patients with significant soft and hard tissue deficiencies not suitable for standard, less constrained, revision knee systems. The combined series included 30 knees with a mean followup of 49 months. Knee Society clinical scores improved from 52 to 134 points. There were no mechanical failures of the implants. The knee system used provides press-fit diaphyseal stems and metaphyseal filling and loading sleeves, all of which showed apposition and positive remodeling of bone at followup radiographic analysis. The excellent midterm results of this modular, mobile-bearing, linked knee system suggest the orthopaedic surgeon can display increasing confidence in the selection of such a knee system when confronted with catastrophic, salvage knee arthroplasty.