Why are total knees being revised? Aseptic loosening, poly wear, and instability account for up to 59% of revision TKA procedures. Younger and more active patients are placing greater demands on total knee arthroplasty (TKA) implants and international registries have documented a much higher rate of TKA failure in this population. Implant designs utilised in the active patient population should focus on optimisation of long term wear properties and minimising interface stress.

Instability after TKA, often related to technical concerns at the time of the index procedure, accounts for by far the greatest subset of failures, excluding infection, in the early revision TKA patients (<5 years). The inability to achieve a rectangular flexion gap with certain TKA techniques for certain deformities has been documented. The adverse clinical consequence of flexion gap asymmetry has also been published in peer reviewed manuscripts. Techniques should be considered that optimise flexion space balance and enhance mid-flexion stability in active, physically demanding patients.

This surgical demonstration will highlight gap balancing techniques and a new rotating platform TKA system as an option for the active patient population.

Purpose: The effect of cemented total hip arthroplasty (THA) stem surface finish and geometry on clinical outcomes is controversial. This is the first report of results from a multi-center study evaluating a cemented, polished, triple-tapered prosthesis.

Methods: Two-hundred-seventeen C-Stems (DePuy, Warsaw, IN, USA) were implanted consecutively at three centers. Hips with 2-year minimum A-P radiographs receiving prospective clinical and independent retrospective radiographic examinations were included. Seven patients (9 hips) died and two had early revisions (one trauma-induced loosening; one due to poor cement technique). Of 206 hips remaining, 162 reached minimum follow-up. Cement-mantle grade, subsidence, stem-cement radiolucency, femoral osteolysis, and Harris Hip Score (HHS) were recorded annually.

Results: Mean age was 70 years (range 39–100). Of the 162 patients evaluated, 103 were female and 59 male. There were 17 deaths (20 hips) after minimum follow-up. Mean radiographic follow-up was 4 years (range: 2–6). At last follow-up, the mean HHS was 88 (range: 44–100). Cement-mantle grades were: A(27%), B(49%), C1(6%), C2(14%) and undetermined(4%). No stem subsidence greater than 2mm was observed. Debonding more than 1mm was noted in 6 hips (4%), including one cement fracture. Of 3 hips (2%) with femoral osteolysis, two instances were exclusively in proximal zones.

Conclusions: Excellent to good results were obtained in this multi-center, cemented, triple-tapered THA stem series. Radiographic results were similar to published results from other successful stems sharing these features. Further research is warranted to determine whether long-term results compare favorably to others designed to resist subsidence and loosening.