Can Tibial Cementation Be Enhanced in Knee Arthroplasty Surgery?

Abstract

Aseptic loosening of the tibial component continues to be a significant mode of failure in total knee arthroplasty surgery. Surface cemented components preserve tibial bone stock, but are reliant on a strong bone-cement interface. This study compares standard surface cemented tibial component design to a tibial component with the addition of an undersurface cement containment skirt. The hypothesis was that the addition of a 2-mm underside skirt would allow cement containment and pressurization during implantation, which might improve the overall survival. Two identical tibial components were used, out of which one had the 2-mm underside skirt removed for the purposes of this study. Overall, 12 tibial Sawbones were prepared identically and transducers placed in the medial and lateral plateau. Each component was implanted six times, according to the manufacturer's operative technique. The series of implantation experiments showed no difference in cement pressurization (p = 0.86) regardless of the tibial component design used, with a wide variation in pressure measurements occurring in both groups. The tibial component skirt has not demonstrated any enhancement in cement pressurization. The cement containment skirt might still be advantageous by increasing the cement mantle thickness without causing excessive bone penetration; however, the biological effects cannot be predicted without further clinical evaluation.

The Effect of Tranexamic Acid and Tourniquet Use on Tibial Cement Penetration in Primary Total Knee Arthroplasties

“…Although total knee arthroplasties (TKAs) are widely and successfully used in osteoarthritis, aseptic loosening of the tibial component is still one of the most important issues [1][2][3]. Aseptic loosening may be caused by individual differences, the surgical technique, or the type of implants used [2,4]. The strength of the cement-bone interface is extremely important in the survival of the TKA and the need for revision [5][6][7][8].…”

“…Cement must be able to penetrate the cancellous bone under the tibial component in sufficient amounts and homogeneously [2,7,9]. Penetration is related with the type of cement used, the cementation technique, and the cleanliness of the bone surface [10][11][12].…”

Effect of tourniquet application on cement penetration in primary total knee arthroplasty: a meta-analysis

“…Aseptic loosening may be associated with individual differences, surgical techniques, and the type of implants used [4,6]. The strength of the cement-bone interface is also important for the TKA survivorship and related revision [7][8][9][10][11].…”