Schaffler Benjamin C, Robin Joseph X, Katzman Jonathan, Arshi Armin, Rozell Joshua C, Schwarzkopf Ran
Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
J Arthroplasty. 2025 Jul;40(7):1869-1874. doi: 10.1016/j.arth.2024.12.023. Epub 2024 Dec 20.
The cementation technique is crucial for achieving adequate fixation and optimal survivorship in total knee arthroplasty (TKA). The thickness of the cement at the tibial bone-implant surface may be related to aseptic tibial loosening. However, to date, no studies have demonstrated a direct association between cement thickness and rates of aseptic tibial loosening.
We performed a retrospective review to identify 28,327 primary cemented TKAs with at least 2 years of follow-up at an academic health system from 2013 to 2021. A total of 115 cases underwent revision surgery for aseptic tibial loosening. Cases where the implant was recalled specifically for loosening (n = 23) were excluded. The remaining 92 aseptic tibial loosening cases were 2:1 propensity score matched and implant matched to control patients who did not have tibial loosening. There were two independent reviewers who then measured the thickness of the cement interface in 10 locations along the bone-implant interface from initial postoperative radiographs. The averages of the reviewers' measurements were calculated and then compared using independent t-tests.
Aseptic tibial loosening cases involving implant A tibial baseplate (n = 75) had significantly thinner cement interfaces than matched controls at all the 10 locations measured. Aseptic loosening cases involving implant B (n = 17) also displayed a thinner cement interface than matched controls in all locations, but this result was only statistically significant at the medial baseplate, medial keel, lateral keel, anterior keel, and posterior baseplate.
In two widely used TKA systems, tibial aseptic loosening was associated with significantly thinner cement interfaces when compared to propensity-matched controls in two different implant types. Further prospective studies are needed to identify the optimal keel preparation and design as well as minimal cement interface thickness to avoid implant loosening.
III.
骨水泥固定技术对于全膝关节置换术（TKA）实现充分固定和最佳生存率至关重要。胫骨骨-植入物表面的骨水泥厚度可能与无菌性胫骨松动有关。然而，迄今为止，尚无研究证明骨水泥厚度与无菌性胫骨松动率之间存在直接关联。
我们进行了一项回顾性研究，以确定2013年至2021年在一个学术医疗系统中至少随访2年的28327例初次骨水泥固定TKA病例。共有115例因无菌性胫骨松动接受了翻修手术。专门因松动而召回植入物的病例（n = 23）被排除。其余92例无菌性胫骨松动病例与未发生胫骨松动的对照患者进行了2:1倾向评分匹配和植入物匹配。然后，由两名独立的审阅者从术后初始X线片上沿着骨-植入物界面的10个位置测量骨水泥界面厚度。计算审阅者测量值的平均值，然后使用独立t检验进行比较。
在所有测量的10个位置，涉及植入物A胫骨基板的无菌性胫骨松动病例（n = 75）的骨水泥界面明显比匹配的对照薄。涉及植入物B的无菌性松动病例（n = 17）在所有位置的骨水泥界面也比匹配的对照薄，但这一结果仅在内侧基板、内侧龙骨、外侧龙骨、前龙骨和后基板处具有统计学意义。
在两种广泛使用的TKA系统中，与两种不同植入物类型的倾向匹配对照相比，胫骨无菌性松动与明显更薄的骨水泥界面相关。需要进一步的前瞻性研究来确定最佳的龙骨准备和设计以及最小的骨水泥界面厚度，以避免植入物松动。
III级
