Page 41 - JCTR-10-4

Journal of Clinical and Translational Research 2024; 10(4): 263-268

Journal of Clinical and Translational Research

Journal homepage: http://www.jctres.com/en/home

ORIGINAL ARTICLE

Do cement pockets prevent fluid contamination of the undersurface of

tibial baseplates?

Bryce Biberstein , Aleksander Mika *, Hillary Mulvey , Phillip Butcher , William Gilbert , J. Ryan Martin 1
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1 Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America, Department of
Mechanical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
ARTICLE INFO ABSTRACT
Article history: Background: Aseptic loosening remains one of the most frequent causes of implant failure
Received: June 19, 2024 following primary total knee arthroplasty (TKA). Prior literature has established that these failures
Accepted: August 13, 2024 appear to occur at the implant-cement interface—likely secondary to lipid contamination. Implant
Published Online: August 29, 2024 manufacturers have incorporated cement pockets on the undersurface of tibial implants to improve
fixation.
Keywords: Aim: The study aimed to determine if cement pockets prevent lipid contamination of the
Total knee arthroplasty implant-cement interface.
Primary Methods: A contemporary total knee tibial baseplate has recently incorporated cement pockets
Implant design on its implants. We modeled clear acrylic tibial baseplate molds of this implant with and without
Aseptic loosening cementation pockets. We then simulated an experimental cementing process with the introduction
Aseptic tibial loosening of lipids at the implant-cement interface. The surface area contamination at this interface was
Aseptic failure quantified using ImageJ software and presented as a percentage of the total baseplate surface area
Lipid contamination available for fixation.
Cement debonding Results: For the predecessor implant design without cementation pockets, the average tibial
baseplate lipid contamination was 42.82%. The average tibial baseplate lipid contamination was
*Corresponding author: 30.36% for the contemporary implant design with cementation pockets. The addition of cement
Aleksander Mika pockets was found to significantly reduce lipid contamination (p = 0.0265).
Department of Orthopedic Surgery, Vanderbilt Conclusion: Lipid contamination of the implant-cement interface remains a primary mechanism
University Medical Center, Nashville, of implant failure following primary TKA. We found that the addition of cement pockets decreased
Tennessee, United States of America. the surface area of implant contamination with fluid. Therefore, while it is unclear whether cement
Email: aleksander.mika@vumc.org pockets improve implant fixation, they do appear to reduce fluid/lipid contamination and alternative
undersurface geometries and techniques should be considered to help prevent lipid contamination.
© 2024 Author(s). This is an Open- Relevance for Patients: Cement pockets and other undersurface designs may help prevent aseptic
Access article distributed under the terms loosening, which has become a leading cause of revision surgery for persistently painful and/or
of the Creative Commons Attribution- unstable TKA in patients.
Noncommercial License, permitting all
non-commercial use, distribution, and
reproduction in any medium, provided the
original work is properly cited. 1. Introduction

The increasing demand for total knee arthroplasty (TKA) leads to a corresponding
increase in TKA revisions [1]. Aseptic loosening remains one of the most common
causes of TKA failure. A recent study demonstrated that aseptic loosening increased by
97% as the underlying indication for TKA revision from 2009 to 2014, with projections
continuing to increase into 2030 [2].
The etiology surrounding the aseptic loosening of TKA is still debated. With the
introduction of highly cross-linked polyethylene in 1998 and the use of modern implants,
lysis-related failures have significantly decreased [3,4]. In contemporary practice, the
implant-cement interface appears to be the “weak-link” of component fixation [5,6]. It
DOI: https://doi.org/10.36922/jctr.24.00029