As we try to standardize implant selection and force surgeons into a round hole, it will be harder and harder to select implants based on our clinical judgment. There are no other monolithic implants on the market that allow me to “straddle” this old ACL screw and avoid having to remove it. This is a Monolithic uncemented implant w arguably the most potential for the longest survivorship. If this implant is not “on contract” then I would have to argue and argue and email and email until i get the implant approved to use. Part of the trade off as health care transitions from the old model where I could use anything and everything whenever I want at whatever price. Patient is approx 8 y out from this tka and was approx 50yo at the time of surgery.