A low-profile offset stem tibial implant includes a tray with a plate that extends transversely around a first tibial axis. The plate includes a distal surface adapted to engage against the prepared surface of the tibia. An engagement portion extends away from the distal surface of the plate substantially along the first tibial axis. A stem is provided with a distal end adapted to be introduced into the medullary canal of the tibia along a second tibial axis and a proximal end. One or more adapter elements are provided with a proximal portion sized to engage with the engagement portion of the plate along the first tibial axis. The adapter element also includes a distal portion adapted to engage with the proximal end of the stem along the second tibial axis. The adapter element permits adjustment of the medio-lateral and antero-posterior position of the second tibial axis relative to the first tibial axis. A plurality of indexing features are located at an interface between the plate and the adapter element to secure the tray in at least three discrete locations around the first tibial axis when in an assembled configuration.