Bone Ongrowth of Contemporary Cementless Tibial Components: A Retrieval Analysis

Cementless total knee arthroplasty is gaining interest as total knee arthroplasty patients become younger, more active, and interested in long-term biologic fixation. New porous coatings have altered mechanical properties to improve bone osseointegration, although limited data exist on this topic. We measured the bone ongrowth on retrieved tibial trays to determine how demographic, radiographic, or implant design factors correlate with ongrowth.

Twenty retrieved trays were assessed from 3 designs: Zimmer NexGen Trabecular Metal (n = 9), Stryker Triathlon Tritanium (n = 6), and Biomet Vanguard Regenerex (n = 5). Exclusion criteria included revision for aseptic loosening or early postoperative infection. Ongrowth on the tibial components and on corresponding pegs (if accessible) was assessed. The amount of osseointegration was reported as the bone directly opposed to the surface divided by the available area for ongrowth. Radiographs were reviewed for alignment and regions of biologic fixation.

Bone ongrowth covered 65% ± 19% of the tibial tray surface and did not differ among manufacturers (P = .27). Medial pegs had less ongrowth than lateral pegs (39% vs 64%, P = .02). Vanguard medial pegs had less ongrowth than NexGen medial pegs (15% vs 61%, P = .03). Length of implantation was different between the NexGen (55 months) and Triathlon (24 months, P < .05) design only. Patient and radiographic data demonstrated no correlation with ongrowth.

An average 65% of the porous tibial tray surface had ongrowth at revision. These values are consistent with manufacturing claims for excellent bone ongrowth for newer porous coatings.