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Techniques for improving the initial strength of the tibial tray-cement interface bond
F Billi1, A Kavanaugh1, H Schmalzried2
1UCLA/OIC Department of Orthopaedic Surgery, David Geffen School of Medicine, Los Angeles, California, USA.
The Bone & Joint Journal
|January 17, 2019
Summary
To improve total knee arthroplasty (TKA) implant strength, cement the tibial component soon after mixing and ensure the keel and plateau are cemented. Avoiding contamination significantly enhances the tibial implant/cement interface strength.
Area of Science:
- Orthopedic surgery
- Biomaterials engineering
- Implant fixation
Background:
- Tibial component loosening is a frequent reason for revision total knee arthroplasty (TKA).
- Optimizing the initial tibial implant/cement interface strength is crucial for long-term implant survival.
- Limited data exists on surgical techniques that yield the strongest initial interface.
Purpose of the Study:
- To investigate the impact of eight variables on the initial strength of the tibial baseplate/cement interface.
- To identify optimal surgical techniques for maximizing tibial component fixation in TKA.
Main Methods:
- 48 tibial trays were cemented into acrylic holders using two cement manufacturers.
- Variables tested included timing of cement application (early, normal, late), cementing technique (plateau only vs. plateau and keel), and contamination with marrow fat.
- Push-out tests were conducted to measure interface strength.
Main Results:
- Early cementing significantly increased interface strength (48-72%) compared to normal conditions.
- Late cementing drastically reduced strength (47-73%).
- Cementing the keel substantially enhanced strength (147-153%).
- Marrow fat contamination severely weakened the interface (94-99%), but pre-coating the tray reduced this effect (43-65%).
Conclusions:
- Maximize tibial tray/cement interface strength by applying cement promptly after mixing.
- Thoroughly avoid contamination of the interface with biological materials like marrow fat.
- Utilize a cementing technique that includes both the tibial plateau and the keel for superior fixation.
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