Cementing the tibial component in total knee arthroplasty: which technique is the best?

Aseptic loosening of the tibial component remains a major cause of failure in total knee arthroplasty and may be related, directly or indirectly, to micromotion. Therefore, good fixation of the tibial component is a prerequisite to achieve long-term success of the implant. Cementing technique is one of the factors that play a role in this respect. We investigated the effect of different cementing techniques on the cement penetration in the proximal tibia. We compared 5 different cementing techniques in an anatomical open pore sawbone model (n = 25), using a contemporary total knee arthroplasty design and standard polymethylmetacrylate cement. We demonstrated that applying cement to both the undersurface of the tibial baseplate and as well as onto the tibial bone, either by a spatula or fingerpacking technique, leads to an optimal cement penetration of 3 to 5 mm. When cement is applied only onto the tibial component, penetration is insufficient. When a cement gun is used, cement penetration is too excessive.