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One potential solution is the addition of an intramedullary stem to the femoral component. However, the optimal stem length remains unclear. In this study, we aimed to determine the optimal stem length using finite element models. Finite element models of femurs were developed with unstemmed prostheses and prostheses with stem lengths of 50, 75, and 100\u2009mm. Under squat loading conditions, the von Mises stress at the notch and stress distribution on four transversal sections of the femur were analyzed. Additionally, micromotion of the prosthesis\u2013bone interface was evaluated to assess initial stability. The unstemmed prosthesis exhibited a von Mises stress of 191.8\u2009MPa at the notch, which decreased to 43.1, 8.8, and 23.5\u2009MPa for stem lengths of 50, 75, and 100\u2009mm, respectively. The stress reduction on four selected femoral transversal sections compared with the unstemmed prosthesis was 40.0%, 84.4%, and 67.1% for stem lengths of 50, 75, and 100\u2009mm, respectively. Micromotion analysis showed a maximum of 118.8\u2009\u03bcm for the unstemmed prosthesis, which decreased significantly with the application of stems, particularly at the anterior flange. Intramedullary stems effectively reduced stress concentration at the femoral notch. The 50\u2010mm stem length provided the optimal combination of reduced notch stress, minimized stress\u2010shielding effect, and decreased micromotion at the anterior flange.<\/jats:p>","DOI":"10.1002\/cnm.3842","type":"journal-article","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T07:35:04Z","timestamp":1722843304000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Stem to prevent periprosthetic fracture after notching in total knee arthroplasty"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7730-8001","authenticated-orcid":false,"given":"Qian","family":"Wan","sequence":"first","affiliation":[{"name":"Department of Orthopedics The Second Hospital of Jilin University  Changchun 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