Tapered modular fl uted titanium stems for femoral fi xation in revision total knee arthroplasty

Consensus regarding femoral stem fixation options in revision total knee arthroplasty remains controversial. Tapered, modular, fluted titanium (TMFT) stems have an excellent track record in total hip arthroplasty for their ability to provide axial and rotational stability in situations of compromised host bone. We present 3 successfully treated cases in which the Food & Drug Administration granted permission to use custom TMFT stems in situations of failed femoral fixation in multiple revised knees. These stems hold promise to achieve stable fixation in revision total knee arthroplasty where host metadiaphyseal bone is deficient. Implant manufactures should consider dedicating future resources to create adapters that can link existing successful TMFT stems currently used in hip arthroplasty to revision total knee components when host bone is severely compromised. © 2017 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

[1]  Szu-Yuan Chen,et al.  Superior Survivorship of Cementless vs Cemented Diaphyseal Fixed Modular Rotating-Hinged Knee Megaprosthesis at 7 Years' Follow-Up. , 2017, The Journal of arthroplasty.

[2]  A. Hanssen,et al.  Long-Term Results After Total Knee Arthroplasty with Contemporary Rotating-Hinge Prostheses , 2017, The Journal of bone and joint surgery. American volume.

[3]  A. Wymenga,et al.  Comparable Stability of Cemented vs Press-Fit Placed Stems in Revision Total Knee Arthroplasty With Mild to Moderate Bone Loss: 6.5-Year Results From a Randomized Controlled Trial With Radiostereometric Analysis. , 2017, The Journal of arthroplasty.

[4]  A. Wymenga,et al.  No Difference in Implant Micromotion Between Hybrid Fixation and Fully Cemented Revision Total Knee Arthroplasty: A Randomized Controlled Trial with Radiostereometric Analysis of Patients with Mild-to-Moderate Bone Loss. , 2016, The Journal of bone and joint surgery. American volume.

[5]  A. Ranawat,et al.  Stem length in revision total knee arthroplasty , 2015, Current Reviews in Musculoskeletal Medicine.

[6]  W. Mihalko How Do I Get What I Need? Navigating the FDA's Custom, Compassionate Use, and HDE Pathways for Medical Devices and Implants. , 2015, The Journal of arthroplasty.

[7]  D. Campanacci,et al.  What Was the Survival of Megaprostheses in Lower Limb Reconstructions After Tumor Resections? , 2015, Clinical orthopaedics and related research.

[8]  P. Ruggieri,et al.  Survival of Modern Knee Tumor Megaprostheses: Failures, Functional Results, and a Comparative Statistical Analysis , 2015, Clinical Orthopaedics and Related Research.

[9]  F. Haddad,et al.  Zonal fixation in revision total knee arthroplasty. , 2015, The bone & joint journal.

[10]  S. Odum,et al.  Clinical & radiographic outcomes of cemented vs. diaphyseal engaging cementless stems in aseptic revision TKA. , 2014, The Journal of arthroplasty.

[11]  J. Parvizi,et al.  Revision total knee arthroplasty in the young patient: is there trouble on the horizon? , 2014, The Journal of bone and joint surgery. American volume.

[12]  W. Hamilton,et al.  Are Cementless Stems More Durable Than Cemented Stems in Two-stage Revisions of Infected Total Knee Arthroplasties? , 2014, Clinical orthopaedics and related research.

[13]  T. Gross,et al.  Total knee arthroplasty with fully porous-coated stems for the treatment of large bone defects. , 2013, The Journal of arthroplasty.

[14]  J. Healey,et al.  Compress® Knee Arthroplasty Has 80% 10-year Survivorship and Novel Forms of Bone Failure , 2012, Clinical orthopaedics and related research.

[15]  A comparison of modular tapered versus modular cylindrical stems for complex femoral revisions. , 2013, The Journal of arthroplasty.

[16]  Jacob T. Munro,et al.  Role and results of tapered fluted modular titanium stems in revision total hip arthroplasty. , 2012, The Journal of bone and joint surgery. British volume.

[17]  D. Regis,et al.  Femoral revision with the Wagner tapered stem: a ten- to 15-year follow-up study. , 2011, The Journal of bone and joint surgery. British volume.

[18]  B. Masri,et al.  Femoral Revision Hip Arthroplasty: A Comparison of Two Stem Designs , 2010, Clinical orthopaedics and related research.

[19]  J. Kabo,et al.  Cemented Distal Femoral Endoprostheses for Musculoskeletal Tumor: Improved Survival of Modular versus Custom Implants , 2009, Clinical orthopaedics and related research.

[20]  S. Kurtz,et al.  Future Young Patient Demand for Primary and Revision Joint Replacement: National Projections from 2010 to 2030 , 2009, Clinical orthopaedics and related research.

[21]  R. Lehman,et al.  Effect of distal stem geometry on interface motion in uncemented revision total hip prostheses. , 2007, American journal of orthopedics.

[22]  E. Garcia-Cimbrelo,et al.  Radiographic bone regeneration and clinical outcome with the Wagner SL revision stem: a 5-year to 12-year follow-up study. , 2007, The Journal of arthroplasty.

[23]  P. Böhm,et al.  The Use of Tapered Stems for Femoral Revision Surgery , 2004, Clinical orthopaedics and related research.

[24]  S. Odum,et al.  Stem Fixation in Revision Total Knee Arthroplasty: A Comparative Analysis , 2003, Clinical orthopaedics and related research.