Abstract
Background
Aseptic tibial loosening following primary total knee replacement is one of the leading
causes of long-term failure. Cement mantle thickness has been implicated as a source
of aseptic tibial loosening. Therefore, the following study was designed to determine
(1) what is the cement mantle thickness in patients that develop aseptic tibial loosening,
and (2) is there a difference in cement mantle thickness based on the interface of
failure?
Method
This retrospective cohort included 216 patients revised for aseptic tibial loosening.
Patient demographics, operative data, and clinical outcomes were recorded. A preoperative
radiographic assessment was performed to determine the interface of failure and the
thickness of the cement mantle using the Knee Society Radiographic Evaluation System
zones.
Results
The average patient age was 65 years and body mass index was 33.7 kg/m2. 203 patients demonstrated radiographic failure at the implant-cement interface and
13 patients demonstrated failure at the cement-bone interface. The average cement
mantle thickness of each radiographic zone for the entire cohort on the AP and lateral
views was 4.4 and 4.5 mm, respectively. The average cement mantle thickness of patients
that developed failure at the implant-cement interface was significantly greater than
patients that failed at the cement-bone interface in each radiographic zone (p < 0.001).
Conclusions
Patients that develop implant loosening at the cement-bone interface were noted to
have a significantly decreased cement mantle compared to patients that failed at the
implant-cement interface. Methods for decreasing tibial implant loosening should likely
focus on improving the fixation at the implant-cement interface.
Keywords
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Article info
Publication history
Published online: December 31, 2022
Accepted:
December 13,
2022
Received in revised form:
November 27,
2022
Received:
April 5,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
