Abstract
Loosening is generally the most common reason for revision TKA. In the AOA NJR, the rate of revision varies depending on fixation. Cemented fixation has a lower rate of revision than cementless fixation; 6.7% vs. 8.2% at 14 years. Loosening does occur more frequently in younger patients and in males. Tibial component loosening is the most common. There is an opportunity for improvement. More durable fixation can be achieved through improved cement technique, rather than going cementless.
De-bonding of the tibial baseplate from the cement is the mechanism of failure in up to 2.9% of total knee arthroplasties. Among seven surgeons at one center, there was a 6.4 fold range (0.7%-4.5%) in the occurrence of such loosening with the same prosthesis. This surgeon-related variability in tibial component de-bonding indicates that surgical technique influences loosening. In a laboratory study, earlier application of cement to metal increases bond strength (p<0.01) while later application reduces bond strength (p<0.05). Fat contamination of the tibial tray-cement interface reduces bond strength, but application of cement to the underside of the tibial tray prior to insertion substantially mitigates this (p<0.05).
