Underhang of the tibial component increases tibial bone resorption after total knee arthroplasty

  • ShiZhong Gu
  • Shinichi Kuriyama
  • Shinichiro Nakamura
  • Kohei Nishitani
  • Hiromu Ito
  • Shuichi Matsuda



One of the causes of aseptic loosening is marked tibial bone resorption (TR) at the tibial bone–component interface after total knee arthroplasty (TKA). It was hypothesized that insufficient coverage of the tibial component and improper cementing technique would cause increased TR after cemented TKA.


One hundred thirty-four primary TKAs in 107 patients with varus osteoarthritis were included in this study. The relationships between the TRs at 2 years after TKA and the tibial component underhang (TUH), the thickness of the cement mantle around the keel, and clinical parameters were evaluated.


The widths of TRs on anteroposterior radiographs were significantly larger on the medial side than on the lateral side (p = 0.001), whereas the difference between the anterior and posterior sides on lateral radiographs was relatively small. Multiple regression analyses showed that medial TR was positively related to medial TUH (p = 0.006), and lateral TR was positively related to a thicker distal cement mantle (p = 0.027). On the lateral view, stepwise selection indicated that postoperative knee flexion angle was the most significant risk factor (p = 0.005) for anterior TR, and posterior TUH was the strongest predictor (p = 0.001) of posterior TR.


To avert postoperative progressive TR, surgeons should perfectly fit a suitably sized tibial component to the medial edge of the tibia. Also, care should be taken to avoid an excessive cement mantle at the distal portion of the keel during TKA.

Level of evidence



Cemented Total knee arthroplasty (TKA) Tibial bone resorption Aseptic loosening Tibial component underhang Thicker cement mantle 



There was no funding for this study.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest in association with the present study.

Ethical approval

All procedures were in accordance with the ethical standards of our institutional research committee.

Informed consent

Informed consent was obtained from all study participants.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
  2. 2.Department of Orthopaedic Surgery, Sports Medicine and Joint SurgeryThe First Hospital of China Medical UniversityShenyangChina

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