Rebuilding the Skeleton, Stems, Metal Augments, and Discipline

Bony deficiencies are commonly encountered during revision total knee arthroplasty. Stems are used routinely to offload epiphyseal fixation, and both fully cemented and press-fit stems have demonstrated excellent survivorship in recent studies. Ease of removal, if needed, end of stem pain concerns, anatomic variability, and bone quality can influence stem-fixation method selection. Metal augments are available in various shapes and sizes to allow efficient management of epiphyseal defects and a modular approach to gap balancing. Larger defects can be managed with trabecular metal cones and metaphyseal filling sleeves, which have demonstrated encouraging results in recent studies. These newer implants are available in a variety of shapes and sizes and allow the efficient management of larger defects not handled easily by other methods.