Clinical Update

Are tibial stem extensions preferred
for obese patients?

Personalized implant selection in primary TKR

The global prevalence of knee replacement surgery has significantly increased over the last decades and this trend is expected to continue in the coming years.1 During the same period, the prevalence of obesity has also dramatically increased.2 While the rise of obesity has been observed in many countries, it was particularly pronounced in the United States where more than two in every three adults are now overweight or obese.3  This global phenomenon combined with an increased demand for TKR, will ultimately lead to growing numbers of obese patients receiving a TKR.4 

In this Vu Medi debate, Dr. Giles Scuderi, MD advocates for using tibial stem extensions in obese patients in order to improve implant fixation and so reduce the incidence of component loosening and revisions. Dr. Scuderi also describes his tibial stem of choice, and his cementing technique for this patient group. He recognises that there is obviously a cost associated with using stem extensions in these patients, but believes that cost to be significantly lower than that of a revision surgery for component loosening.

  1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89:780–785. Find the source here.
  2. Lifshitz F, Lifshitz JZ. Globesity: the root causes of the obesity epidemic in the USA and now worldwide. Pediatr Endocrinol Rev. 2014; 12:17–34. Find the source here.
  3. Parratte S, et al. Do Stemmed Tibial Components in Total Knee Arthroplasty Improve Outcomes in Patients with Obesity? Clin Orthop Relat Res (2017) 475:137–145 DOI 10.1007/s11999-016-4791-6. Find the source here.
  4. Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011; 378:815–825. Find the source here.


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