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Aseptic Tibial Component Loosening After Total Knee Arthroplasty

March 01, 2020

Contributors: Zachary Berliner, MD; Jean Fleuriscar Jr, BS; Jose A Rodriguez, MD, FAAOS; Travis M Weiner; Luke Gregory Menken, DO

Keywords: Complications

2020 AWARD WINNER Aseptic tibial component loosening after total knee arthroplasty is a considerable cause of late failure. This video discusses surgical techniques that can be used to prevent aseptic tibial component loosening. Malalignment, particularly tibial varus greater than or equal to 3° and sagittal slope less than 0° or greater than 7°, is a predisposing factor for aseptic tibial component loosening. This video demonstrates the careful use of conventional guides and anatomic landmarks to properly align the tibial component. Cementation also is a crucial factor to optimizing tibial implant longevity. Cement may fail at the implant-cement interface and the bone-cement interface. The video demonstrates the application of low-viscosity cement to the tibial plateau and keel early in its polymerization, which has been reported to result in optimal implant-cement fixation. After the cement is a doughy consistency, it is pressurized into the canal and onto the tibial cut surface to achieve ideal interdigitation. Our standard of care does not involve the use of a tourniquet. We use longer irrigation time and maintain a systolic blood pressure of less than 95 mm Hg to achieve a clear surgical field. To evaluate our technique, we performed a retrospective review of 167 of our recent total knee arthroplasty procedures with the use of conventional anatomic alignment guides. Our results show reproducible neutral alignment of the tibial component in the coronal and sagittal planes. In addition, we found no statistical difference in cement mantle thickness between patients in whom a tourniquet was used and patients in whom a tourniquet was not used.