MacDonald SJ. Fluted tapered stems: Modular and monoblock – making them work. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 8-11, 2021; Orlando (hybrid meeting).

MacDonald SJ. Fluted tapered stems: Modular and monoblock – making them work. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 8-11, 2021; Orlando (hybrid meeting).

When using a modular or monoblock fluted tapered stem in femoral defects, surgeons need to properly plan and have consistent reaming depth, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting.

In his presentation, Steven J. MacDonald, MD, FRCSC, noted it is critical to plan and template preoperatively, including identifying the stem length and diameter, the anterior femoral bow, how to restore leg length and offset, and whether an extended trochanteric osteotomy needs to be performed.

“All of these things put together are telling me I can achieve stability in the OR with this stem and, again, for the majority of cases you can,” MacDonald said. “You have all done preop planning before. It is not any different for these but is critical to do.”

According to MacDonald, distal reaming is the most important step of the surgical technique, with accurate depth and diameter essential for a successful surgery. MacDonald noted surgeons need to have a reproducible ream to the same depth each time.

“It’s important because if you don’t get that right, you’re going to have problems with reproducible seating of the implant,” MacDonald said.

He added intraoperative radiographs are useful either with the final trial or reamer or final stem in place, especially when first learning the technique.

“You’re checking the correct stem diameter you’ve achieved, the length you’ve achieved, making sure you don’t have any distal fracture, but you’re checking the final construct before leaving the OR and being in the recovery room,” MacDonald said.

Although the techniques are similar with modular and monoblock components, MacDonald said the technique is “more exacting with a monoblock.”

“Expect an absolute firm endpoint,” MacDonald said. “The way I like to do it is I do slow, steady blows. I take a marking pen and horizontally mark the implant itself so that as you’re impacting it against the femur, you can see that implant going in.”

Get the latest news and education delivered to your inbox

© 2021 Healio All Rights Reserved.

Get the latest news and education delivered to your inbox

© 2021 Healio All Rights Reserved.