Use of stems in revision total knee arthroplasty

Abstract

Revision total knee arthroplasty is becoming an increasingly common reconstructive procedure. As the number of primary total knee arthroplasties continues to increase on a yearly basis, the need for revision surgery will likewise increase exponentially. Therefore, it is important to determine the best surgical techniques to manage revision problems as they are encountered. Most major manufacturers of total knee replacement offer modular revision knee systems. They use modular augmentations to deal with tibial and femoral bone loss. Most also feature intramedullary jig systems to make accurate revision bone cuts. In addition, manufacturers provide a variety of stems to enhance fixation in revision situations.Variable length stems designed to engage in the metaphysis or diaphysis are commonly offered options. Offset stems are also available to deal with altered anatomy. This variety of stems can be implanted in a press-fit or cemented fashion. Despite this wide array of options available, little comparative information exists to guide the revision knee surgeon in making a proper prosthetic selection for his patient. This chapter reviews the salient biomechanical literature available regarding stem fixation as well as reviews the effect of canal filling stem fixation on limb alignment and implant position. A comparative study concerning methods of stem fixation is also presented, along with current recommendations for stem use in revision TKA. © 2005 Springer Science+Business Media, Inc. All rights reserved.