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Extent of vertical cementing as a predictive factor for radiolucency in revision total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Limited information is available regarding the effects of cementing extent on implant stability in patients who have undergone revision total knee arthroplasty (TKA). As such, the goals of this study were: (1) to determine the correlation between the extent of vertical cementing and implant loosening; (2) to determine whether the extent of cementing is a potential predictive factor for radiolucency; and (3) to evaluate the minimal amount of cement needed for a stable implant during revision TKA using a hybrid technique.

Methods

One hundred nine stemmed/revision TKAs with a mean follow-up period of 5 years were retrospectively analysed. In each case, a single varus–valgus constrained implant was used and fixed with a hybrid technique. Implant stability was evaluated according to the modified Knee Society radiographic scoring system. The extent of vertical cementing was defined as the longitudinal length from the implant base to the end of the radiopaque line around the stem on radiograph. Its correlation with implant stability was analysed, and the minimal value for a stable implant was evaluated with a receiver operating characteristic (ROC) analysis.

Results

The mean extent of vertical cementing was longer in stable implants (femur: p = 0.001, tibia: p = 0.004) and significantly correlated with implant stability (femur: p < 0.001, tibia: p = 0.001). A logistic regression analysis revealed that the risk of loosening was 8.7–16.1 times higher when the extent of cementing was <40 mm, which was located at the stem–implant junction of the modular implant. The minimal extent of vertical cementing was estimated to be 60 mm for a stable femoral implant and 50 mm for a tibial implant.

Conclusions

The hybrid fixation technique with a cementing extent >60 mm for the femur and 50 mm for the tibia was durable at a mean follow-up period of 5 years. Vertical cementing 10–20 mm above the stem–implant junction is recommended when performing revision TKA using this technique.

Level of evidence

IV.

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Acknowledgments

The authors wish to thank Eun Mi Shin and Son Mi Ahn for supporting our research with collecting and organising the clinical data. We also appreciate statistical consultation provided by the Medical Research Collaborating Center at the Seoul National University College of Medicine/Seoul National University Hospital. This work was supported by the Ministry of Trade, Industry and Energy (MOTIE) Grant funded by the Korean government (No. 10045329). Grant was used for laboratory fees and salaries. The funding sources did not play a role in performing investigations for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Du Hyun Ro, Yool Cho, Sahnghoon Lee, Kee Yun Chung, Seong Hwan Kim, Young Min Lee & Myung Chul Lee

  2. Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796, Korea

    Joon Kyu Lee

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  1. Du Hyun Ro
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Correspondence to Myung Chul Lee.

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Ro, D.H., Cho, Y., Lee, S. et al. Extent of vertical cementing as a predictive factor for radiolucency in revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24, 2710–2717 (2016). https://doi.org/10.1007/s00167-016-4011-7

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