Case series report: Early cement-implant interface fixation failure in total knee replacement

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Implant Failure Analysis

Background:

• Early aseptic loosening is an uncommon complication of cemented total knee replacement (TKR).
• A series of early TKR failures due to cement-implant fixation issues prompted this investigation.
• Understanding the causes of early failure is crucial for improving TKR outcomes.

Purpose of the Study:

• To report a case series of early failures in cemented total knee replacement (TKR).
• To identify potential causes for aseptic loosening related to cement-implant fixation.
• To investigate the role of high viscosity cement (HVC) in early TKR failures.

Main Methods:

• A retrospective review of 3048 primary TKRs performed between May 2005 and December 2010.
• Analysis of nine early failures in eight patients across two total knee systems.
• Focus on cases utilizing high viscosity cement (HVC) for tibial component fixation.

Main Results:

• Aseptic loosening of the tibial component was the primary failure mode in all nine cases.
• The high viscosity bone cement (HVC) demonstrated poor adherence to tibial trays during revision surgery.
• HVC was consistently used in all observed early TKR failures.

Conclusions:

• The mechanical properties of high viscosity cement (HVC) may increase susceptibility to early aseptic loosening in TKRs.
• Similar issues with HVC have been reported in total hip replacement (THR), including cement micro-fractures and debris.
• Further research is warranted to evaluate the long-term performance and safety of HVC in TKR procedures.