The effect of stem design on end-of-stem pain in revision total knee arthroplasty

A series of 143 revision total knee arthroplasties was evaluated using a Knee Society clinical score, radiographic assessment, and satisfaction questionnaire. Patients completed a pain drawing showing the location and severity of pain they experienced at 2 years follow-up. Two stem designs were used: a solid, fluted cobalt chrome stem (group I) and a slotted titanium stem (group II). End-of-stem pain was associated with solid cobalt chrome stems while a lower incidence of stem pain was associated with slotted titanium stems. Symptoms were intermittent and activity related in all but 2 cases, but none required component revision. The presence of end-of-stem pain did appear to be clinically significant because patients with this pain were more likely to be only somewhat satisfied or dissatisfied with their degree of pain relief compared to those without end-of-stem pain. Stem design does appear to impact the incidence of end-of-stem pain in revision total knee arthroplasty.