Cemented tibial stems are not requisite in revision.

Tibial stems are necessary in most total knee revisions to share the load and protect the fixation interface of the tibial tray. Successful use of a tibial stem requires independent stability of the stem with or without cement. Some additional geometry on the undersurface of the tibial tray such as peripheral pegs or fins is necessary to provide additional resistance to rotatory stresses if the stem is not cemented. Cementing the tibial stem works. However, with the excellent results of cementless stems, who would want to deal with cement removal in those few cases of loosening or the occasional case with infection or instability? The disadvantages of a press-fit stem are not seen with modem tibial stems, such as with a long conical stem with an offset attachment to the tibial baseplate as used in this series. Cement is not necessary!