SURGICAL TECHNIQUE: Diaphyseal Press-Fit Stem Use in Revision TKA
When considering whether to use diaphyseal press-fit stems in a revision total knee arthroplasty (TKA), the surgeon needs to keep in mind these 3 principles:
- The stem must be diaphyseal-engaging – ideally, 4 cm of diaphyseal engagement.
- Offset may be needed to avoid medial overhang in the tibia and to accommodate the bow of the femur.
- Short metaphyseal press-fit stems do not work.
That was the message from Jeremy M. Gililland, MD, in his presentation on diaphyseal press-fit stems at ICJR’s annual Revision Hip & Knee Course. Dr. Gililland, from the University of Utah in Salt Lake City, reviewed the pros and cons of these stems, noting the following advantages:
- They allow reproducible fixation, with 0% aseptic loosening reported in a study of 184 revision TKAs. 
- They allow reproducible alignment because the femur and tibia guide the implant into position. (This assumes fairly well-aligned canals. If that’s not the case, a diaphyseal press-fit stem is not the right choice, as discussed below.)
- They allow for easier revision in the future because there will not be any cement to remove from the diaphysis.
There are, of course, a few disadvantages:
- As mentioned above, diaphyseal press-fit stems are not appropriate in patients with a large metaphyseal/diaphyseal alignment mismatch due to the risk of component malalignment.
- End-of-stem pain occurs in some patients, estimated at 2% to 30% depending on the study.
To help surgeons use these stems appropriately, Dr. Gililland showed a video of the technique and briefly reviewed data on diaphyseal press-fit stems that he and his colleagues have published. [1,2] Click the image above to watch Dr. Gililland’s presentation.
Dr. Gililland has no disclosures relevant to this presentation.
- Peters CL, Erickson JA, Gililland JM. Clinical and radiographic results of 184 consecutive revision total knee arthroplasties placed with modular cementless stems. J. Arthroplasty. 2009 Sep;24(6 Suppl):48-53. doi: 10.1016/j.arth.2009.04.033. Epub 2009 Jun 24.
- Gililland JM, Gaffney CJ, Odum SM, Fehring TK, Peters CL Beaver WB. Clinical & radiographic outcomes of cemented vs. diaphyseal engaging cementless stems in aseptic revision TKA. J Arthroplasty. 2014 Sep;29(9 Suppl):224-8. doi: 10.1016/j.arth.2014.03.049. Epub 2014 May 24.