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The Exorcist III, aka Exorcist III: Legion, is based on Legion, William Peter Blatty's 1983 followup novel to The Exorcist (1971), the novel that started the Exorcist franchise. The film originally shared its title with the novel, but studio pressure forced a title change from Legion to The Exorcist III: Legion and finally just The Exorcist III. The film is generally quite faithful to the novel, with a few changes being made - most notably at the ending, which was reshot when the studio wanted an exorcism in the film. The novel was adapted for the movie by Blatty himself.

Prior to The Exorcist III, there was The Exorcist (1973) (1973) and Exorcist II: The Heretic (1977) (1977). Exorcist: The Beginning (2004) followed in 2004 and Dominion: Prequel to the Exorcist (2005) in 2005.

While it ignores the previous sequel, it never actually outright contradicts it, despite William Peter Blatty's well-known dislike of Exorcist II: The Heretic (1977). In fact, the shots of the stairs where Karras died are carefully framed so as not to show the MacNeil's former house, which was destroyed at the end of the previous film.

Regan is only mentioned in retrospect as the "MacNeil kid" involved in an exorcism several years prior. In fact, the two sequels to the first Exorcist show the fates of two different sets of characters - Exorcist II: The Heretic (1977) shows what happened to Regan, Sharon and Merrin (in the afterlife, at least) and mentions what Chris is doing, while Exorcist III shows what happened to Kinderman, Dyer and Karras.

Originally Brad Dourif played Karras in all the scenes, but the producers asked Jason Miller to film some scenes as Karras, so that there would be at least one major actor returning from the first film. According to William Peter Blatty, the idea is that when Karras appears as himself he's under the control of dozens of different personalities, all evil souls that have been planted in his body by the Devil. However, James Venamun, a.k.a. the Gemini Killer is the dominant personality at all times, and quite often pushes the others out of the way completely and takes sole control of Karras's body; this is what's happening when we see Dourif playing him. It should be noted that Karras/Gemini isn't actually shapeshifting - Kinderman and the orderlies only ever see him as Karras (i.e. Miller), and his appearance as the Gemini is something only the audience sees.

There were 17 years between the first and third Exorcist films, plenty of time to strike up a friendship. However, this seeming incongruity is in fact a result of some editing done on the first film. A slightly different ending for the first Exorcist was filmed where Kinderman meets Dyer after the MacNeils have left Georgetown, and the two become friends as they walk down the street. William Friedkin cut the sequence from the first film because he felt Dyer standing at the top of the stairway was a better image to go out on, but it was eventually restored by William Peter Blatty in the 2000 re-release of the film ("The Version You've Never Seen") so that there would be better continuity between the first and third films.

This one's a bit harder to explain, as Kinderman says during the movie that Karras was his best friend. In the novel on which the movie is based, there is more exposition about the two characters' relationship. As this movie is primarily an adaptation of the novel, William Peter Blatty has presumably followed the source material rather than create a direct sequel to The Exorcist (1973).