Uncemented Tapered Stems



Uncemented Tapered Stems


Timothy S. Brown

Michael J. Taunton



Key Concepts



  • The starting point for preparation of the femur is key and can differ by implant.


  • Special attention must be paid to lateralize during the preparation process to keep the final component from being placed in a varus position.


  • Stable initial fixation with scratch-fit and appropriate stem sizing is critical for long-term ingrowth and implant fixation.


Sterile Instruments and Implants



  • Retractors specific for the surgeon’s preferred approach (Figure 7.1)


  • Round high-speed burr


  • Reamers, broaches, trials specific to the selected cementless tapered implant (Figures 7.2 and 7.3)


Surgical Approaches



  • Posterolateral: Care must be taken when reaming to avoid extending the femoral component.


  • Anterolateral: Care must be taken when reaming to avoid flexing the femoral component.


  • Direct anterior: Adequate exposure of the femur is necessary for safe preparation. The abdomen may push the reamer into varus and flexion.


Preoperative Planning



  • Preoperative evaluation of the femoral bone quality and any deformity can help the surgeon decide which type of stem will fit best. A tight canal with a wide metaphysis may be more amenable to a ream and broach system that allows expansion of the diaphysis to allow for a sufficiently large stem to provide good fit in the metaphysis.


  • Preoperative templating for femoral stem sizing and position is useful for planning stem insertion relative to the greater trochanter (Figure 7.4).


Bone, Implant, and Soft Tissue Techniques



  • After initial exposure of the proximal femur, a sharp Hohmann retractor is placed on the anterior border of the greater trochanter to move the gluteus medius and minimus away from the path of reaming and broaching.


  • An entry point posterolaterally near the piriformis fossa is made with the high-speed burr (Figure 7.5).


  • A T-handled starting reamer is used to define the femoral canal.







Figure 7.1 â–ª Retractors utilized by authors for a primary posterior approach.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Dec 14, 2019 | Posted by in ORTHOPEDIC | Comments Off on Uncemented Tapered Stems

Full access? Get Clinical Tree

Get Clinical Tree app for offline access