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The Journal of Bone and Joint Surgery, Vol 76, Issue 1 60-65, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Radiolucency at the bone-cement interface in total knee replacement. The effects of bone-surface preparation and cement technique
MA Ritter, SA Herbst, EM Keating and PM Faris
Center for Hip and Knee Surgery, Mooresville, Indiana 46158.
Three hundred and sixty-three knees (221 patients) that had been treated
with total arthroplasty between 1975 and 1985 were divided into three
groups on the basis of the preparation of the surface of the bone and the
technique of the cement application. Group 1 (155 knees) was treated with
irrigation of the bone surfaces with a syringe and manual packing of the
bone cement. Group 2 (sixty-one knees) had high-volume, high-pressure
lavage of the bone surfaces and manual packing of the cement. Group 3 (147
knees) had high-volume, high-pressure lavage and pressure injection of
low-viscosity methylmethacrylate cement. Radiolucency was evaluated at each
follow-up interval, and the findings were subjected to chi-square analysis
and Kaplan-Meier survival analysis. Chi-square analysis of the data at one
and three years indicated a significantly higher frequency of lines at the
bone-cement interface in the femur and tibia in Group-1 knees compared with
those in Groups 2 and 3. The survival curves showed increasing rates of
radiolucency adjacent to the tibial components of the knees that had been
prepared with lavage that was not high-volume and high-pressure and that
had been prepared with finger-packing of cement (Group 1). This may
partially explain the clinical problem of loosening of tibial components
despite acceptable alignment. This study demonstrates that proper
preparation of the cancellous bone and pressurization of the cement reduce
the initial occurrence of a radiolucent line, which may have a positive
effect on the ultimate failure of at least the tibial component.
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