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Total knee replacement with interlocking stems: a preliminary report.

J J Rodrigo1, S J Hazelwood, T B Farver

  • 1University of California, Davis Medical Center, Sacramento 95817, USA.

Clinical Orthopaedics and Related Research
|November 22, 2001
PubMed
Summary
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Long-stemmed knee prostheses fixed with screws offer a viable solution for extensive bone loss in total knee replacements. This method shows good fixation, improved patient outcomes, and reduced stress-shielding in most cases.

Area of Science:

  • Orthopedic surgery
  • Biomedical engineering

Background:

  • Revision and primary total knee replacements with significant bone loss often necessitate long-stemmed prostheses for component stabilization.
  • The use of interlocking screws for fixing these long-stemmed components is explored as a method to enhance stability and long-term outcomes.

Observation:

  • Ten patients undergoing total knee replacement with long-stemmed prostheses and interlocking screw fixation were evaluated over a minimum of two years.
  • Outcomes including functional scores (Short Form-12), pain levels, and radiographic evidence of stem fixation and bone remodeling were assessed pre- and postoperatively.

Findings:

  • Eighty percent of long-stemmed prostheses demonstrated good fixation on serial radiographs, with significant improvements in functional scores and pain post-surgery.
  • Positive bone remodeling was observed in 80% of patients, indicating minimal stress-shielding, although 20% experienced significant stress-shielding in the metaphysis.

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  • Complications included two periprosthetic fractures and one infection, neither of which required revision surgery.

    • Implications:

    • Long-stemmed total knee components with interlocking screw fixation represent a practical alternative for managing large bone defects in the femur or tibia during knee replacement surgery.
    • This technique appears to provide stable fixation, improve patient function, and promote favorable bone remodeling, though potential for stress-shielding should be monitored.