Tibial Implant Fixation Behavior in Total Knee Arthroplasty: A Study With Five Different Bone Cements

Abstract

Background: The objectives of this study are to (1) evaluate if there is a potential difference in cemented implant fixation strength between tibial components made out of cobalt-chromium (CrCoMo) and of a ceramic zirconium nitride (ZrN) multilayer coating and to (2) test their behavior with 5 different bone cements in a standardized in vitro model for testing of the implant-cement-bone interface conditions. We also analyzed (3) whether initial fixation strength is a function of timing of the cement apposition and component implantation by an early, mid-term, and late usage within the cement-specific processing window. Methods: An in vitro study using a synthetic polyurethane foam model was performed to investigate the implant fixation strength after cementation of tibial components by a push-out test. A total of 20 groups (n ¼ 5 each) was used: Vega PS CrCoMo tibia and Vega PS ZrN tibia with the bone cements BonOs R, SmartSet HV, Cobalt HV, Palacos R, and Surgical Simplex P, respectively, using mid-term cement apposition. Three different cement apposition timesdearly, mid-term, and late usagedwere tested with a total of 12 groups (n ¼ 5 each) with the bone cements BonOs R and SmartSet HV. Results: There was no significant difference in implant-cement-bone fixation strength between CrCoMo and ZrN multilayer-coated Vega tibial trays tested with 5 different commonly used bone cements. Conclusion: Apposition of bone cements and tibial tray implantation in the early to mid of the cementspecific processing window is beneficial in regard to interface fixation in TKA.

Bond strength of metal-free polyether-ether-ketone knee prostheses compared to metal knee prostheses with bone cement: A preliminary in vitro study

“…28 In previous studies, push-out test was used to investigate the bond strength between the prosthesis and cement. 29 For this study, we used shear test to verify the bond strength. 30,31 After shear testing, PEEK tibial prostheses demonstrated a slightly lower bond strength to bone cement compared to metal prostheses.…”

Higher revision rates and aseptic loosening with posterior-stabilised total knee endoprosthesis compared to the cruciateretaining type of the same implant model- a single-centre retrospective study analysing 580 total knee arthroplasties

“…During the revision of cases with aseptic loosening in our study, bonding failure was noticed at the implant-cement interface, while the bonding at the cement-bone interface was good, implicating possible unsatisfactory tibial component surface roughness (Figure 2). An in-vitro study by Grupp et al compared implant fixation strength after cementation by a pushout test between three tibial base plates with different surface roughnesses, while five different types of bone cement were used for fixation 13 . The tibial implant with the lowest roughness showed lower push-out force, with a bonding failure at the implant-cement interface.…”

Factors affecting aseptic loosening in primary total knee replacements: an in vitro study

“…However, a trend for inferior cement adhesion to ceramic was noted in the published data. This study was flawed due to the complexity of failure modes of sheer and bonding pull off failure that were not isolated [9]. It also should raise some concern in the orthopedic community that there are in fact differences in adhesion properties between certain cement brands and may extend to the technique the surgeon utilizes in terms of early verses late curing phase.…”