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Biberstein et al. | Journal of Clinical and Translational Research 2024; 10(4): 263-268 267
pockets, there were several notable limitations. First, this was an doi: 10.1016/j.artd.2023.101152
experimental model with inherent design limitations. The fluid [2] Schwartz AM, Farley KX, Guild GN, Bradbury TL Jr.
characteristics were meant to mimic what potentially happens Projections and Epidemiology of Revision Hip and Knee
during surgery, but the volume and location of fluid may not Arthroplasty in the United States to 2030. J Arthroplasty
be representative. Second, the material properties of acrylic 2020;35:S79-85.
are not the same as cobalt-chromium or titanium. However, doi: 10.1016/j.arth.2020.02.030
we still believe that the propagation of fluids at the implant- [3] De Steiger RN, Muratoglu O, Lorimer M, Cuthbert AR,
cement interface behaves similarly, whether PMMA bone Graves SE. Lower Prosthesis-Specific 10-Year Revision
cement or modeling dough is being tested. In addition, a direct Rate with Crosslinked than with Non-Crosslinked
correlation between aseptic loosening and lipid contamination Polyethylene in Primary Total Knee Arthroplasty. Acta
remains somewhat theoretical. Methods for detecting lipid Orthop 2015;86:721-7.
contamination are not currently available; therefore, determining
direct causation remains elusive. Finally, while we believe that doi: 10.3109/17453674.2015.1065046
cementation pockets will lead to improved fixation strength [4] Wilhelm SK, Henrichsen JL, Siljander M, Moore D,
by decreasing fluid contamination under tibial baseplates, we Karadsheh M. Polyethylene in Total Knee Arthroplasty:
recognize that our study model does not assess this outcome Where Are We Now? J Orthop Surg (Hong Kong)
or any other potential detrimental effects of tibial undersurface 2018;26:2309499018808356.
geometry changes, such as mechanical failures [23]. doi: 10.1177/2309499018808356
[5] Martin JR, Otero JE, Mason JB, Fehring TK. Where
5. Conclusion
Is the “Weak Link” of Fixation in Contemporary
The addition of cement pockets in a contemporary TKA Cemented Total Knee Replacements? J Arthroplasty
tibial baseplate was associated with a significant reduction in 2021;36:2497-501.
lipid contamination compared to its predecessor design without doi: 10.1016/j.arth.2021.02.029
pockets. Our study demonstrated that approximately 30 – 40% [6] Cox ZC, Green CC, Otero JE, Mason JB, Martin JR.
of the tray can be contaminated with only three drops of fluid. Varus Collapse in Total Knee Arthroplasty: Does Fixation
Improvements in cement techniques could help limit lipid or Bone Fail First? J Arthroplasty 2022;37:162-7.
contamination of the tibial tray, while current tibial implant doi: 10.1016/j.arth.2021.09.012
design features may reduce lipid dispersion at the implant- [7] Randall DJ, Anderson MB, Gililland JM, Peters CL,
cement interface.
Pelt CE. A Potential Need for Surgeon Consensus:
Acknowledgments Cementation Techniques for Total Knee Arthroplasty
in Orthopedic implant Manufacturers’ Guidelines
None. Lack Consistency. J Orthop Surg (Hong Kong)
Funding 2019;27:2309499019878258.
doi: 10.1177/2309499019878258
None. [8] Martin JR, Archibeck MJ, Gililland JM, Anderson LA,
Conflicts of Interest Polkowski GG, Schwarzkopf R, et al. Trends in Total
Knee Arthroplasty Cementing Technique among
The authors declare no competing interests. Arthroplasty Surgeons-A Survey of the American
Association of Hip and Knee Surgeons Members.
Ethics Approval and Consent to Participate J Arthroplasty 2022;38:S233-8.e6.

Not applicable. doi: 10.1016/j.arth.2022.12.034
Consent for Publication [9] Martin JR, Wronski PT, Schilkowsky RM, Orfanos
AV, Fehring TK, Mason JB, et al. Chitranjan S.
Not applicable. Ranawat Award: Motion During Total Knee Cementing
Significantly Decreases Tibial Implant Fixation Strength.
Availability of Data J Arthroplasty 2022;37:S12-8.
Data are available from the corresponding author upon doi: 10.1016/j.arth.2022.02.091
reasonable request. [10] Karpiński R, Szabelski J, Krakowski P, Jonak J, Falkowicz K,
Jojczuk M, et al. Effect of Various Admixtures on
References Selected Mechanical Properties of Medium Viscosity

[1] Shichman I, Askew N, Habibi A, Nherera L, Macaulay W, Bone Cements: Part 1 - α/β Tricalcium Phosphate (TCP).
Seyler T, et al. Projections and Epidemiology of Revision Compos Struct 2024;343:118306.
Hip and Knee Arthroplasty in the United States to 2040- doi: 10.1016/j.compstruct.2024.118306
2060. Arthroplasty Today 2023;21:101152. [11] Karpiński R, Szabelski J, Krakowski P, Jonak J, Falkowicz K,

DOI: https://doi.org/10.36922/jctr.24.00029