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Longer stems may have disadvantages including stress shielding along the length of the stem with associated reduction in bone density and a theoretical risk of subsidence and loosening, peri-prosthetic fracture and end-of-stem pain. These features make long stems unattractive in the primary TKR setting, but often desirable in revision surgery with bone loss and instability. In the revision scenario, stems are beneficial in order to convey structural stability to the construct and protect the reconstruction of bony defects. Cemented and uncemented long stemmed implants have different roles depending on the nature of the bone loss involved.<\/jats:p><jats:p>This review discusses the biomechanics of the design of tibial components and stems to inform the selection of the component and the technique of implantation.<\/jats:p>","DOI":"10.1302\/0301-620x.94b8.28289","type":"journal-article","created":{"date-parts":[[2012,7,28]],"date-time":"2012-07-28T08:37:00Z","timestamp":1343464620000},"page":"1009-1015","source":"Crossref","is-referenced-by-count":99,"title":["The role of the design of tibial components and stems in knee replacement"],"prefix":"10.1302","volume":"94-B","author":[{"given":"C. E. H.","family":"Scott","sequence":"first","affiliation":[{"name":"Royal Infirmary of Edinburgh, Department of Orthopaedics, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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