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Cemented stems are requisite in revision knee replacement.

Obtaining rigid prosthesis fixation in bone loss can be a significant challenge during revision total knee replacement (TKR).1 Stemmed prosthetic components off load stresses at the damaged metaphyseal interfaces, bypass bone defects, and provide additional prosthetic surface area for fixation.1-4 Relatively little longterm data exists documenting the durability of stemmed revision TKR and controversy remains as to whether these stems should be cemented or uncemented (press-fit).2,4,5 It is important to note that the indications and surgical techniques for cemented and press-fit stems differ.4-6 Depending on the prosthesis system used, the technique and philosophy of press-fit stem design varies significantly.7,8 The choice between press-fit or cemented stems has primarily been based on personal philosophy and vague surgical indications for each specific technique.2 No prospective studies compare these two techniques in patients with similar amounts of bone loss, but it is likely that cemented stems are used more commonly in severe cases of bone loss or when higher degrees of articular constraint are deemed necessary.2 Press-fit stems require more length (75150 mm) and should engage the diaphysis to achieve stabilization of the tibial tray, which is equivalent to a short stem cemented into the metaphyseal region.9,10