Tibial Stems in Revision Total Knee Arthroplasty: Is There an Anatomic Conflict?

Gobba, Mohamed; Chan, N; Patel, Rikin; Noble, Philip C.; Incavo, Stephen J.

doi:10.1016/j.arth.2014.12.039

Cited by 20 publications

(12 citation statements)

References 10 publications

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“…In contrast to others, who found that the use of modular stemmed The Journal of Knee Surgery prosthesis in primary surgery could be associated with negative effect and early loosening in addition to difficult revision. 13,14 Gobba et al 15 reported that the use of stemmed tibial tray might force the tibial component into mal-position especially with the use of large diameter stems (120--200 mm). We did not record this finding as a complication in our study because of the use of undersize stem diameter (9-10 mm) to avoid impingement of the stem with the inner surface of the medullary canal.…”

Section: Discussionmentioning

confidence: 99%

Tibial Tray with a Stem: Does It Have Any Role in Primary Cemented Total Knee Replacement?

Samy

Azzam

2020

J Knee Surg

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Over many decades, total knee replacement (TKR) becomes the ideal treatment option for advanced arthritis. Many designs were introduced to increase the stability of the tibial tray, hence the longevity of the prosthesis. This retrospective study was performed on 168 patients who received NexGen cemented primary total knee either with standard tibial tray (group A) or tibial tray with an intramedullary stem (group B) between May 2008 and May 2017. We reviewed all preoperative and postoperative clinical and radiological data retrospectively. In addition, a prospective clinical and radiological reassessment was done. Our aim was to answer the following questions: (1) Is there any difference between both groups in regard to clinical and radiological results? (2) Is there any difference in the revision rate? (3) Is there a role of using stemmed tibial tray in primary TKR? Better results were recorded in obese and severely obese patients having stemmed cemented tibial tray and so for patients with marked and severe preoperative varus angle. Our recommendations are to use cemented tibial tray with a stem in complicated primary surgery without fear of adverse effects on short and intermediate terms of follow-up.

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Section: Discussionmentioning

confidence: 99%

Tibial Tray with a Stem: Does It Have Any Role in Primary Cemented Total Knee Replacement?

Samy

Azzam

2020

J Knee Surg

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“…Tibial stems are an important tool for complex total knee arthroplasty (TKA). Stem extensions are routinely utilized in revision TKA when proximal tibial bone is compromised as they significantly reduce compressive and shear forces on proximal tibial cancellous bone [ 1 ]. They are increasingly utilized in obese patients [ 2 ] to minimize the risk of catastrophic varus collapse associated with unstemmed implants [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is well recognized by cementless stem users that valgus bowing of the tibia in the coronal plane requires recognition and technical judgment to avoid an insertional fracture or malpositioning at the joint line [ 1 ]. In such situations, offset stems can be used to avoid medial overhang if a canal-filling, diaphyseal-engaging cementless stem is used.…”

Section: Introductionmentioning

confidence: 99%

Variability of Sagittal Plane Proximal Tibial Morphology and Its Effect on Stem Placement in Total Knee Arthroplasty

Secrist¹,

Rowe

Li³

et al. 2022

Arthroplasty Today

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The tibial joint line is offset posteriorly relative to the tibial sagittal anatomic axis. This can have consequences when using stemmed implants during total knee arthroplasty. We retrospectively analyzed native knee lateral radiographs in 100 patients. The distance between the sagittal anatomic axis and the center of a simulated tibial resection was calculated as a percentage of overall tibial width. Analysis of 5 manufacturers’ baseplates showed that the tibial stem attached on average 10% anterior to the midline. We measured the impingement point of a 12-mm-diameter stem starting from this position. The tibial joint surface was offset posteriorly from the anatomic axis in all patients by an average of 23.5% of the tibial width (range: 13.1%-33.2%). A 12-mm tibial stem would impinge within 40 mm in 2% (2/100) of patients and within 60 mm in 19% (19/100). There was a weak but statistically significant correlation between proximal tibial offset and distance to impingement. During total knee arthroplasty, the center of the cut tibia is offset posteriorly from the sagittal anatomic axis. In patients with high offset, tibial stem extensions can impinge against the posterior tibia, causing baseplate malpositioning, diminished cement mantle, or fracture.

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“…Gobba et al24) demonstrated that a 120 mm tibial stem will force the tibial component into an excessively valgus position, and a 200 mm tibial stem will often force the tibial component into a posteromedial position above the tibial surface. Therefore, proper surgical strategies are required to prepare a cut surface that facilitates the entry of the long stem.…”

Section: Introductionmentioning

confidence: 99%

Stem Fixation in Revision Total Knee Arthroplasty: Indications, Stem Dimensions, and Fixation Methods

Kang

Park

Song

2018

Knee Surg Relat Res

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Although stems improve initial mechanical stability in revision total knee arthroplasty (TKA), ideal indications, proper lengths and diameters, and appropriate fixation methods remain controversial. The topics of the present article include the indications, selection of lengths and diameters, and fixation methods of stems in revision TKA. The use of a stem in revision TKA can protect the juxta-articular bone. A stem cannot be a substitute for optimal component fixation; it plays an adjunctive role in transferring the loads from the compromised metaphysis to the stronger diaphysis. Proper bone surface preparation and appropriate use of the stem based on a great store of knowledge are required to support the stemmed components effectively in revision TKA. The balance between overshielding and overloading the juxta-articular bone would provide excellent structural protection. The stem length and diameter should be tailored according to patients’ anatomical characteristics and determined fixation strategy. There are two traditional methods of stem fixation including the total cementation technique and the hybrid technique with a cementless press-fit stem. Selection of a cementation technique should be based on thorough consideration of advantages and disadvantages of each technique.

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Tibial Stems in Revision Total Knee Arthroplasty: Is There an Anatomic Conflict?

Cited by 20 publications

References 10 publications

Tibial Tray with a Stem: Does It Have Any Role in Primary Cemented Total Knee Replacement?

Tibial Tray with a Stem: Does It Have Any Role in Primary Cemented Total Knee Replacement?

Variability of Sagittal Plane Proximal Tibial Morphology and Its Effect on Stem Placement in Total Knee Arthroplasty

Stem Fixation in Revision Total Knee Arthroplasty: Indications, Stem Dimensions, and Fixation Methods

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