Similar Revision Rates for High- and Low-Viscosity Cement in Total Knee Arthroplasty

The use of high-viscosity cement in total knee arthroplasty (TKA) has been increasing, and reports in the literature suggest high-viscosity cement may be associated with a higher failure rate. We sought to review a statewide database regarding the frequency of high-viscosity cement usage and compare the failure rate of high-viscosity cement to low-viscosity cement. In addition, we evaluated the impact of antibiotic additives to cement as a potential confounding variable.

This is a retrospective cohort study using statewide data from 2012 to 2022. Over this period, 176,216 cases were classified into high/medium/low viscosity categories to track the frequency of use for each type of cement. Cumulative percent revision curves were then generated using Kaplan-Meier for each category. The use of antibiotics in cement and the impact on survival were evaluated.

By category of cement used, 57.9% were high-viscosity, 2.3% medium-viscosity, and 39.8% low-viscosity. Revision rates were similar between high-viscosity cement and low-viscosity cement. An increase in the failure rate of medium-viscosity cement was associated with low surgeon volumes. The use of antibiotic-impregnated cement was 43.1%. All-cause revision rates were similar between cement with or without antibiotics.

Within this database, most TKA cases use high-viscosity cement. The revision rate was similar between high-viscosity cement and low-viscosity cement. The use of antibiotic cement does not seem to impact survival, as the all-cause revision rates were similar between cement with and without antibiotics.

This is a retrospective cohort study, so the level of evidence is III.