Revision TKA procedures are increasing in frequency as the rates of primary TKA continue to increase. Stems are mandatory to transfer stress away from the epiphysis into the diaphysis. Major metaphyseal bone defects are often present and need to be properly addressed to prevent failure despite stem use. Modular implants, with variable constraints and attachment sites for augments and stems, are a significant advance, as are the availability and use of porous metal cones and sleeves and offset stem capabilities. Improvement in surgical technique is evidenced, particularly with press-fit fixation.
Both fully cemented and hybrid stem fixations have advantages and disadvantages, but the best mode of fixation remains controversial. Based on the review of the available literature, difference in outcome between either techniques was not found to conclusively demonstrate the superiority of one technique over the other. However, few studies suggest superiority of the hybrid fixation over the fully cemented technique, the difference is at best marginal, and clinical heterogeneity in most of the studies is level 3 and level 4.
Each case should be individualized, and the potential risks and benefits of all fixation methods should be weighed for a given patient's specific case.
J Am Acad Orthop Surg. 2022;30(9):e703-e713. © 2022 American Academy of Orthopaedic Surgeons