Table. 1.

Advantages and disadvantages of short metaphyseal-engaging stems vs. longer diaphyseal-engaging stems

	Metaphyseal-engaging stems (MES)	Diaphyseal-engaging stems (DES)
Length	30–75 mm	>75 mm
Fixation	Generally cemented	Generally uncemented
Advantages	Small adjustments possible in medial/lateral and anterior/posterior directions	Diaphyseal referencing to help with component alignment
	Avoids limb deformity or ipsilateral hardware	Easier to remove if revision required
	Less end-of-stem pain	Applicable in patients with previous distal femoral or proximal tibial osteotomy
Disadvantages	Difficult to remove, can lead to more bone loss	End-of-stem pain
	Decreased references for proper component alignment	Without offset options can force articular components into suboptimal position
		Risk of periprosthetic fracture with canal preparation
		May not be applicable in setting of dysplasia or ipsilateral hardware