Skip to main content
SpringerLink
Log in

The effect of multiple drilling on a sclerotic proximal tibia during total knee arthroplasty

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

To assess the depth of cement penetration and the occurrence of radiolucent line (RLL) according to drill bit diameter used in multiple drilling for the sclerotic bone of the medial proximal tibia during total knee arthroplasty (TKA).

Methods

The multiple drilling procedure was performed with 2.0 mm diameter in group 1 (n = 290) and with 4.5 mm diameter in group 2 (n = 109) to enhance the cement penetration. The postoperative RLL in the cement-bone interface and the depth of cement penetration were measured under the tibial implant at three, six, 12 and 24 months after TKA. The progression of RLL was also evaluated at the latest follow-up.

Results

Cumulative occurrence rates of RLLs were significantly lower in group 2 than in group 1 at 12 and 24 months postoperatively (P = 0.005 and 0.004). The depth or width was increased in nine cases only in group 1 at the latest follow up. There was no tibial implant loosening in both groups at the latest follow-up. Mean maximal depths of cement penetration were 1.1 mm in group 1 and 4.8 mm in group 2 at three months (P < 0.001).

Conclusions

Our comparative study between the different diameters used during multiple drilling for the tibial sclerotic surface suggests that a multiple drilling technique with a larger diameter of 4.5 mm can improve the depth of cement penetration and reduce the occurrence rate of RLLs after TKAs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Windsor RE, Scuderi GR, Moran MC, Insall JN (1989) Mechanisms of failure of the femoral and tibial components in total knee arthroplasty. Clin Orthop Relat Res 248:15–20

    PubMed  Google Scholar 

  2. Askew MJ, Steege JW, Lewis JL, Ranieri JR, Wixson RL (1984) Effect of cement pressure and bone strength on polymethylmethacrylate fixation. J Orthop Res 4:412–420

    Google Scholar 

  3. Krause WR, Krug W, Miller J (1982) Strength of the cement-bone interface. Clin Orthop Relat Res 163:290–299

    PubMed  Google Scholar 

  4. Walker PS, Soudry M, Ewald FC, McVickar H (1984) Control of cement penetration in total knee arthroplasty. Clin Orthop Relat Res 185:155–164

    PubMed  Google Scholar 

  5. Smith S, Naima VS, Freeman MA (1999) The natural history of tibial radiolucent lines in a proximally cemented stemmed total knee arthroplasty. J Arthroplasty 14:3–8

    Article  CAS  PubMed  Google Scholar 

  6. Ecker ML, Lotke PA, Windsor RE, Cella JP (1987) Long-term results after total condylar knee arthroplasty Significance of radiolucent lines. Clin Orthop Relat Res 216:151–158

    PubMed  Google Scholar 

  7. Ritter MA, Herbst SA, Keating EM, Faris PM (1994) Radiolucency at the bone-cement interface in total knee replacement The effects of bone-surface preparation and cement technique. J Bone Joint Surg Am 76:60–65

    CAS  PubMed  Google Scholar 

  8. Lutz MJ, Pincus PF, Whitehouse SL, Halliday BR (2009) The effect of cement gun and cement syringe use on the tibial cement mantle in total knee arthroplsty. J Arthroplasty 24:461–467

    Article  PubMed  Google Scholar 

  9. Yoga R, Sivapathasundaram N, Suresh C (2009) Use of cement gun for fixation of tibia component in total knee arthroplasty. Malaysian Orthopaedic Journal 3:72–77

    Article  Google Scholar 

  10. Cawley DT, Kelly N, McGarry JP, Shannon FJ (2013) Cementing techniques for the tibial component in primary total knee replacement. J Bone Joint Surg 95-B:295–300

    Article  CAS  Google Scholar 

  11. Chiu KY, Cheng HC, Yau WP, Tang WM, Ho HS (2010) Reading radiographs after total knee arthroplasty. Hong Kong J Orthop Surg 14:25–39

    Google Scholar 

  12. Kalra S, Smith TO, Berko B, Walton NP (2011) Assessment of radiolucent lines around the Oxford unicompartmental knee replacement: sensitivity and specificity for loosening. J Bone Joint Surg (Br) 93:777–781

    Article  CAS  Google Scholar 

  13. Sadoghi P, Leithner A, Weber P, Friesenbichler J, Gruber G, Kastner N, Pohlmann K, Jansson V, Wegener B (2011) Radiolucent lines in low-contact-stress mobile-bearing total knee arthroplasty: a blinded and matched case control study. BMC Musculoskelet Disord 12:142

    Article  PubMed Central  PubMed  Google Scholar 

  14. Vyskocil P, Gerber C, Bamert P (1999) Radiolucent lines and component stability in knee arthroplasty Standard versus fluoroscopically assisted radiographs. J Bone Joint Surg (Br) 81:24–26

    Article  CAS  Google Scholar 

  15. McCaskie AW, Deehan DJ, Green TP, Lock KR, Thompson JR, Harper WM, Gregg PJ (1998) Randomised, prospective study comparing cemented and cementless total knee replacement: result of press-fit condylar total knee replacement at five years. J Bone Joint Surg (Br) 80:971–975

    Article  CAS  Google Scholar 

  16. Helwig P, Konstantinidis L, Hirschmüller A, Miltenberger V, Kuminack K, Südkamp NP, Hauschild O (2013) Tibial cleaning method for cemented total knee arthroplasty: An experimental study. Indian J Ophthalmol 47:18–22

    Google Scholar 

  17. Van de Groes SA, De Waal Malefijt MC, Verdonschot N (2013) Influence of preparation techniques to the strength of the bone-cement interface behind the flange in total knee arthroplasty. Knee 20:186–190. doi:10.1016/j.knee.2012.08.002

    Article  PubMed  Google Scholar 

  18. Miskovsky C, Whiteside LA, White SE (1992) The cemented unicondylar knee arthroplasty An in vitro comparison of three cement technique. Clin Orthop Relat Res 284:215–220

    PubMed  Google Scholar 

  19. Incavo SJ, Ronchetti PJ, Howe JG, Tranowski JP (1994) Tibial plateau coverage in total knee arthroplasty. Clin Orthop Relat Res 299:81–85

    PubMed  Google Scholar 

  20. Janssen D, Mann KA, Verdonschot N (2008) Micro-mechanical modeling of the cement-bone interface: the effect of friction, morphology and material properties on the micromechanical response. J Biomech 41:3158–3163

    Article  PubMed Central  PubMed  Google Scholar 

  21. Gray HA, Zavatsky AB, Gill HS (2010) The sclerotic line: why it appears under knee replacements (a study based on the Oxford knee). Clin Biomech 25:242–247

    Article  Google Scholar 

  22. Amin A, Al-Taiar A, Sanghrajka AP, Kang N, Scott G (2008) The early radiological follow-up of a medial rotational design of total knee arthroplasty. Knee 15:222–226. doi:10.1016/j.knee.2008.01.004

    Article  CAS  PubMed  Google Scholar 

  23. Bach CM, Biedermann R, Goebel G, Mayer E, Rachbauer F (2005) Reproducible assessment of radiolucent lines in total knee arthroplasty. Clin Orthop Relat Res 434:183–188

    Article  PubMed  Google Scholar 

  24. Guha AR, Debnath UK, Graham NM (2008) Radiolucent lines below the tibial component of a total knee replacement (TKR)—a comparison between single- and two-stage cementation techniques. Int Orthop 32(4):453–457

    Article  PubMed Central  PubMed  Google Scholar 

  25. Cornell CN, Ranawat CS, Burstein AH (1986) A clinical and radiographic analysis of loosening of total knee arthroplasty components using a bilateral model. J Arthroplasty 1:157–163

    Article  CAS  PubMed  Google Scholar 

  26. Harvey IA, Manning MP, Sampath SA, Johnson R, Elloy MA (1995) Alignment of total knee arthroplasty: the relationship to radiolucency around the tibial component. Med Eng Phys 17:182–187

    Article  CAS  PubMed  Google Scholar 

  27. Hvid I, Nielsen S (1984) Total condylar knee arthroplasty. Prosthetic component positioning and radiolucent lines. Acta Orthop Scand 55:160–165

    Article  CAS  PubMed  Google Scholar 

  28. Bloebaum RD, Rubman MH, Hofmann AA (1992) Bone ingrowth into porous-coated tibial components implanted with autograft bone chips Analysis of ten consecutively retrieved implants. J Arthroplasty 7:483–493

    Article  CAS  PubMed  Google Scholar 

  29. Matthew SA, Peter FS, William JH, Richard HR (2004) Knee failure mechanisms after total knee arthroplasty. Techniques in Knee Surgery 3:55–59

    Article  Google Scholar 

  30. Kolisek FR, Mont MA, Seyler TM, Marker DR, Jessup NM, Siddiqui JA, Monesmith E, Ulrich SD (2009) Total knee arthroplasty using cementless keels and cemented tibial trays: 10-year results. Int Orthop 33(1):117–121

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgment

This study was not supported by any foundation.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Seoul, South Korea

    Ji Hyun Ahn, Seung Hyo Jeong & Sung Hyun Lee

Authors
  1. Ji Hyun Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seung Hyo Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sung Hyun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ji Hyun Ahn.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahn, J.H., Jeong, S.H. & Lee, S.H. The effect of multiple drilling on a sclerotic proximal tibia during total knee arthroplasty. International Orthopaedics (SICOT) 39, 1077–1083 (2015). https://doi.org/10.1007/s00264-014-2551-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2551-3

Keywords

Search

Navigation