The optimal strategy for stable tibial fixation in revision TKA

In revision total knee arthroplasty, the optimal strategy for stabilizing the tibial component in the face of proximal defects remains controversial. The stability of a revision tibial prosthesis was measured, while varying the defect treatment proximally and the cortical engagement distally. An offset axial load, in combination with an axial torque, was applied to each specimen to simulate the stance phase of gait. It was found that in revision TKA, the mechanical stability of tibial fixation is increased by the addition of a canal filling stem, especially in the presence of poor proximal bone. Proximal tibial coverage, even with a custom-fitted tibial component, adds little additional stability to a tibial tray stabilized by intramedullary engagement of a canal-filling stem.