Advertisement

The Association Between Cement Viscosity and Revision Risk After Primary Total Knee Arthroplasty

Published:January 26, 2021DOI:https://doi.org/10.1016/j.arth.2021.01.052

      Abstract

      Background

      Recent case series have reported early failure with the use of high-viscosity cement (HVC) in total knee arthroplasty (TKA). We evaluated revision risk after TKA with HVC compared with medium-viscosity cement (MVC) in a large cohort.

      Methods

      We conducted a cohort study using data from Kaiser Permanente’s Total Joint Replacement Registry. Patients who underwent fully cemented primary TKA for osteoarthritis were identified (2001-2018). Only posterior-stabilized, fixed-mobility designs of the 3 highest-volume implant systems (DePuy PFC, Zimmer NexGen, and Zimmer Persona) were included to mitigate confounding from implant characteristics. Palacos (Zimmer/Heraeus) and Simplex (Stryker) cements comprised the HVC and MVC exposure groups, respectively. Propensity score–weighted Cox proportional hazards regression was used to evaluate risk for any revision during follow-up and risk for revision from aseptic loosening specifically.

      Results

      The final cohort comprised 76,052 TKAs, 41.1% using MVC. The crude 14-year cumulative revision probability was 4.55% and 5.12% for TKA with MVC and HVC, respectively. In propensity score–weighted Cox models, MVC compared with HVC had a lower risk of any revision (hazard ratio = 0.82, 95% confidence interval = 0.70-0.95) while no difference was observed for revision from aseptic loosening (hazard ratio = 0.80, 95% confidence interval = 0.56-1.13).

      Conclusion

      While we observed a lower risk for any revision with the use of Simplex MVC compared with Palacos HVC, we did not observe a difference in revision for aseptic loosening specifically. Given the widespread use of HVC, additional research to investigate other HVC and potential mechanisms for failure outside of loosening is warranted.

      Level of Evidence

      Level III.

      Keywords:

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bruyere O.
        • Ethgen O.
        • Neuprez A.
        • Zegels B.
        • Gillet P.
        • Huskin J.P.
        • et al.
        Health-related quality of life after total knee or hip replacement for osteoarthritis: a 7-year prospective study.
        Arch Orthop Trauma Surg. 2012; 132: 1583-1587https://doi.org/10.1007/s00402-012-1583-7
        • Shan L.
        • Shan B.
        • Suzuki A.
        • Nouh F.
        • Saxena A.
        Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis.
        J Bone Joint Surg Am. 2015; 97: 156-168https://doi.org/10.2106/jbjs.m.00372
        • Canovas F.
        • Dagneaux L.
        Quality of life after total knee arthroplasty.
        Orthop Traumatol Surg Res. 2018; 104: S41-S46https://doi.org/10.1016/j.otsr.2017.04.017
        • Dalury D.F.
        Cementless total knee arthroplasty: current concepts review.
        Bone Joint J. 2016; 98-B: 867-873https://doi.org/10.1302/0301-620x.98b7.37367
        • van der List J.P.
        • Sheng D.L.
        • Kleeblad L.J.
        • Chawla H.
        • Pearle A.D.
        Outcomes of cementless unicompartmental and total knee arthroplasty: a systematic review.
        Knee. 2017; 24: 497-507https://doi.org/10.1016/j.knee.2016.10.010
        • Matassi F.
        • Carulli C.
        • Civinini R.
        • Innocenti M.
        Cemented versus cementless fixation in total knee arthroplasty.
        Joints. 2013; 1: 121-125
        • Delanois R.E.
        • Mistry J.B.
        • Gwam C.U.
        • Mohamed N.S.
        • Choksi U.S.
        • Mont M.A.
        Current epidemiology of revision total knee arthroplasty in the United States.
        J Arthroplasty. 2017; 32: 2663-2668https://doi.org/10.1016/j.arth.2017.03.066
        • Breusch S.
        • Malchau H.
        The well-cemented total hip arthroplasty: theory and practice.
        Springer Berlin Heidelberg, Heidelberg, Germany2005
        • Berry D.
        • Lieberman J.
        Surgery of the hip.
        Elsevier, Amsterdam, Netherlands2019
        • Bozic K.J.
        • Kamath A.F.
        • Ong K.
        • Lau E.
        • Kurtz S.
        • Chan V.
        • et al.
        Comparative epidemiology of revision arthroplasty: failed THA poses greater clinical and economic burdens than failed TKA.
        Clin Orthop Relat Res. 2015; 473: 2131-2138https://doi.org/10.1007/s11999-014-4078-8
        • Kelly M.P.
        • Illgen R.L.
        • Chen A.F.
        • Nam D.
        Trends in the use of high-viscosity cement in patients undergoing primary total knee arthroplasty in the United States.
        J Arthroplasty. 2018; 33: 3460-3464https://doi.org/10.1016/j.arth.2018.07.007
        • Vaishya R.
        • Chauhan M.
        • Vaish A.
        Bone cement.
        J Clin Orthop Trauma. 2013; 4: 157-163https://doi.org/10.1016/j.jcot.2013.11.005
        • Monzón R.A.
        • Coury J.G.
        • Disse G.D.
        • Lum Z.C.
        Bone cement in total hip and knee arthroplasty.
        JBJS Rev. 2019; 7: e6https://doi.org/10.2106/jbjs.Rvw.19.00031
        • Sabouret P.
        • Lavoie F.
        • Cloutier J.M.
        Total knee replacement with retention of both cruciate ligaments: a 22-year follow-up study.
        Bone Joint J. 2013; 95-B: 917-922https://doi.org/10.1302/0301-620x.95b7.30904
        • Jauregui J.J.
        • Cherian J.J.
        • Pierce T.P.
        • Beaver W.B.
        • Issa K.
        • Mont M.A.
        Long-term survivorship and clinical outcomes following total knee arthroplasty.
        J Arthroplasty. 2015; 30: 2164-2166https://doi.org/10.1016/j.arth.2015.05.052
        • Ritter M.A.
        • Keating E.M.
        • Sueyoshi T.
        • Davis K.E.
        • Barrington J.W.
        • Emerson R.H.
        Twenty-five-years and greater, results after nonmodular cemented total knee arthroplasty.
        J Arthroplasty. 2016; 31: 2199-2202https://doi.org/10.1016/j.arth.2016.01.043
        • Mikulak S.A.
        • Mahoney O.M.
        • dela Rosa M.A.
        • Schmalzried T.P.
        Loosening and osteolysis with the press-fit condylar posterior-cruciate-substituting total knee replacement.
        J Bone Joint Surg Am. 2001; 83: 398-403https://doi.org/10.2106/00004623-200103000-00012
        • Arsoy D.
        • Pagnano M.W.
        • Lewallen D.G.
        • Hanssen A.D.
        • Sierra R.J.
        Aseptic tibial debonding as a cause of early failure in a modern total knee arthroplasty design.
        Clin Orthop Relat Res. 2013; 471: 94-101https://doi.org/10.1007/s11999-012-2467-4
        • Pitta M.
        • Esposito C.I.
        • Li Z.
        • Lee Y.Y.
        • Wright T.M.
        • Padgett D.E.
        Failure after modern total knee arthroplasty: a prospective study of 18,065 knees.
        J Arthroplasty. 2018; 33: 407-414https://doi.org/10.1016/j.arth.2017.09.041
        • Foran J.R.
        • Whited B.W.
        • Sporer S.M.
        Early aseptic loosening with a precoated low-profile tibial component: a case series.
        J Arthroplasty. 2011; 26: 1445-1450https://doi.org/10.1016/j.arth.2010.11.002
        • Hazelwood K.J.
        • O'Rourke M.
        • Stamos V.P.
        • McMillan R.D.
        • Beigler D.
        • Robb 3rd, W.J.
        Case series report: early cement-implant interface fixation failure in total knee replacement.
        Knee. 2015; 22: 424-428https://doi.org/10.1016/j.knee.2015.02.016
        • Kopinski J.E.
        • Aggarwal A.
        • Nunley R.M.
        • Barrack R.L.
        • Nam D.
        Failure at the tibial cement-implant interface with the use of high-viscosity cement in total knee arthroplasty.
        J Arthroplasty. 2016; 31: 2579-2582https://doi.org/10.1016/j.arth.2016.03.063
        • Buller L.T.
        • Rao V.
        • Chiu Y.F.
        • Nam D.
        • McLawhorn A.S.
        Primary total knee arthroplasty performed using high-viscosity cement is associated with higher Odds of revision for aseptic loosening.
        J Arthroplasty. 2020; 35: S182-S189https://doi.org/10.1016/j.arth.2019.08.023
        • Zelle J.
        • Janssen D.
        • Peeters S.
        • Brouwer C.
        • Verdonschot N.
        Mixed-mode failure strength of implant-cement interface specimens with varying surface roughness.
        J Biomech. 2011; 44: 780-783https://doi.org/10.1016/j.jbiomech.2010.10.037
        • Paxton E.W.
        • Inacio M.C.
        • Khatod M.
        • Yue E.J.
        • Namba R.S.
        Kaiser Permanente National total joint replacement registry: aligning operations with information technology.
        Clin Orthop Relat Res. 2010; 468: 2646-2663https://doi.org/10.1007/s11999-010-1463-9
        • Paxton E.W.
        • Kiley M.L.
        • Love R.
        • Barber T.C.
        • Funahashi T.T.
        • Inacio M.C.
        Kaiser Permanente implant registries benefit patient safety, quality improvement, cost-effectiveness.
        Jt Comm J Qual Patient Saf. 2013; 39: 246-252
        • Paxton E.W.
        • Mohaddes M.
        • Laaksonen I.
        • Lorimer M.
        • Graves S.E.
        • Malchau H.
        • et al.
        Meta-analysis of individual registry results enhances international registry collaboration.
        Acta Orthop. 2018; 89: 369-373https://doi.org/10.1080/17453674.2018.1454383
        • Comfort T.
        • Baste V.
        • Froufe M.A.
        • Namba R.
        • Bordini B.
        • Robertsson O.
        • et al.
        International comparative evaluation of fixed-bearing non-posterior-stabilized and posterior-stabilized total knee replacements.
        J Bone Joint Surg Am. 2014; 96: 65-72https://doi.org/10.2106/jbjs.N.00462
        • Graves S.
        • Sedrakyan A.
        • Baste V.
        • Gioe T.J.
        • Namba R.
        • Martínez Cruz O.
        • et al.
        International comparative evaluation of knee replacement with fixed or mobile-bearing posterior-stabilized prostheses.
        J Bone Joint Surg Am. 2014; 96: 59-64https://doi.org/10.2106/jbjs.N.00556
        • Normand S.T.
        • Landrum M.B.
        • Guadagnoli E.
        • Ayanian J.Z.
        • Ryan T.J.
        • Cleary P.D.
        • et al.
        Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores.
        J Clin Epidemiol. 2001; 54: 387-398https://doi.org/10.1016/s0895-4356(00)00321-8
        • Austin P.C.
        An introduction to propensity score methods for reducing the effects of confounding in observational studies.
        Multivariate Behav Res. 2011; 46: 399-424https://doi.org/10.1080/00273171.2011.568786
        • Stuart E.A.
        • Lee B.K.
        • Leacy F.P.
        Prognostic score-based balance measures can be a useful diagnostic for propensity score methods in comparative effectiveness research.
        J Clin Epidemiol. 2013; 66: S84-S90.e1https://doi.org/10.1016/j.jclinepi.2013.01.013
        • Cutler S.J.
        • Ederer F.
        Maximum utilization of the life table method in analyzing survival.
        J Chronic Dis. 1958; 8: 699-712https://doi.org/10.1016/0021-9681(58)90126-7
        • Crawford D.A.
        • Berend K.R.
        • Nam D.
        • Barrack R.L.
        • Adams J.B.
        • Lombardi Jr., A.V.
        Low rates of aseptic tibial loosening in obese patients with use of high-viscosity cement and standard tibial tray: 2-year Minimum follow-up.
        J Arthroplasty. 2017; 32: S183-S186https://doi.org/10.1016/j.arth.2017.04.018
        • Rey Jr., R.M.
        • Paiement G.D.
        • McGann W.M.
        • Jasty M.
        • Harrigan T.P.
        • Burke D.W.
        • et al.
        A study of intrusion characteristics of low viscosity cement Simplex-P and Palacos cements in a bovine cancellous bone model.
        Clin Orthop Relat Res. 1987; 215: 272-278
        • Kopec M.
        • Milbrandt J.C.
        • Kohut N.
        • Kern B.
        • Allan D.G.
        Effect of bone cement viscosity and set time on mantle area in total knee arthroplasty.
        Am J Orthop (Belle Mead NJ). 2009; 38: 519-522
        • Abbruzzese K.
        • O'Laughlin R.
        • Lee D.
        • Allan D.G.
        • Paliwal M.
        The effect of cement viscosity in total knee arthroplasty.
        in: ASME 2012 International Mechanical Engineering Congress and Exposition. Conference Sponsors: ASME, Houston, TX2012
        • Miller M.A.
        • Goodheart J.R.
        • Izant T.H.
        • Rimnac C.M.
        • Cleary R.J.
        • Mann K.A.
        Loss of cement-bone interlock in retrieved tibial components from total knee arthroplasties.
        Clin Orthop Relat Res. 2014; 472: 304-313https://doi.org/10.1007/s11999-013-3248-4
        • Miller M.A.
        • Terbush M.J.
        • Goodheart J.R.
        • Izant T.H.
        • Mann K.A.
        Increased initial cement-bone interlock correlates with reduced total knee arthroplasty micro-motion following in vivo service.
        J Biomech. 2014; 47: 2460-2466https://doi.org/10.1016/j.jbiomech.2014.04.016
        • Miller M.A.
        • Race A.
        • Gupta S.
        • Higham P.
        • Clarke M.T.
        • Mann K.A.
        The role of cement viscosity on cement-bone apposition and strength: an in vitro model with medullary bleeding.
        J Arthroplasty. 2007; 22: 109-116https://doi.org/10.1016/j.arth.2006.02.076
        • Walker P.S.
        • Soudry M.
        • Ewald F.C.
        • McVickar H.
        Control of cement penetration in total knee arthroplasty.
        Clin Orthop Relat Res. 1984; 185: 155-164
        • Mann K.A.
        • Ayers D.C.
        • Werner F.W.
        • Nicoletta R.J.
        • Fortino M.D.
        Tensile strength of the cement-bone interface depends on the amount of bone interdigitated with PMMA cement.
        J Biomech. 1997; 30: 339-346
        • Cawley D.T.
        • Kelly N.
        • McGarry J.P.
        • Shannon F.J.
        Cementing techniques for the tibial component in primary total knee replacement.
        Bone Joint J. 2013; 95-b: 295-300https://doi.org/10.1302/0301-620x.95b3.29586
        • Lai P.L.
        • Tai C.L.
        • Chu I.M.
        • Fu T.S.
        • Chen L.H.
        • Chen W.J.
        Hypothermic manipulation of bone cement can extend the handling time during vertebroplasty.
        BMC Musculoskelet Disord. 2012; 13: 198https://doi.org/10.1186/1471-2474-13-198
        • Baroud G.
        • Samara M.
        • Steffen T.
        Influence of mixing method on the cement temperature-mixing time history and doughing time of three acrylic cements for vertebroplasty.
        J Biomed Mater Res B Appl Biomater. 2004; 68: 112-116https://doi.org/10.1002/jbm.b.20009
        • Maistrelli G.L.
        • Antonelli L.
        • Fornasier V.
        • Mahomed N.
        Cement penetration with pulsed lavage versus syringe irrigation in total knee arthroplasty.
        Clin Orthop Relat Res. 1995; 312: 261-265
        • Norton M.R.
        • Eyres K.S.
        Irrigation and suction technique to ensure reliable cement penetration for total knee arthroplasty.
        J Arthroplasty. 2000; 15: 468-474https://doi.org/10.1054/arth.2000.2965
        • Banwart J.C.
        • McQueen D.A.
        • Friis E.A.
        • Graber C.D.
        Negative pressure intrusion cementing technique for total knee arthroplasty.
        J Arthroplasty. 2000; 15: 360-367
        • Askew M.J.
        • Steege J.W.
        • Lewis J.L.
        • Ranieri J.R.
        • Wixson R.L.
        Effect of cement pressure and bone strength on polymethylmethacrylate fixation.
        J Orthop Res. 1984; 1: 412-420https://doi.org/10.1002/jor.1100010410
        • Song Y.
        • Zhu F.
        • Lin F.
        • Zhang F.
        • Zhang S.
        Bone quality, and the combination and penetration of cement-bone interface: a comparative micro-CT study of osteoarthritis and rheumatoid arthritis.
        Medicine (Baltimore). 2018; 97: e11987https://doi.org/10.1097/md.0000000000011987
        • Kopec M.
        • Milbrandt J.C.
        • Duellman T.
        • Mangan D.
        • Allan D.G.
        Effect of hand packing versus cement gun pressurization on cement mantle in total knee arthroplasty.
        Can J Surg. 2009; 52: 490-494
        • Lutz M.J.
        • Pincus P.F.
        • Whitehouse S.L.
        • Halliday B.R.
        The effect of cement gun and cement syringe use on the tibial cement mantle in total knee arthroplasty.
        J Arthroplasty. 2009; 24: 461-467https://doi.org/10.1016/j.arth.2007.10.028
        • Vanlommel J.
        • Luyckx J.P.
        • Labey L.
        • Innocenti B.
        • De Corte R.
        • Bellemans J.
        Cementing the tibial component in total knee arthroplasty: which technique is the best?.
        J Arthroplasty. 2011; 26: 492-496https://doi.org/10.1016/j.arth.2010.01.107
        • Billi F.
        • Kavanaugh A.
        • Schmalzried H.
        • Schmalzried T.P.
        Techniques for improving the initial strength of the tibial tray-cement interface bond.
        Bone Joint J. 2019; 101-B: 53-58https://doi.org/10.1302/0301-620x.101b1.Bjj-2018-0500.R1
        • Peters C.L.
        • Craig M.A.
        • Mohr R.A.
        • Bachus K.N.
        Tibial component fixation with cement: full- versus surface-cementation techniques.
        Clin Orthop Relat Res. 2003; 409: 158-168https://doi.org/10.1097/01.blo.0000058638.94987.20
        • Saari T.
        • Li M.G.
        • Wood D.
        • Nivbrant B.
        Comparison of cementing techniques of the tibial component in total knee replacement.
        Int Orthop. 2009; 33: 1239-1242https://doi.org/10.1007/s00264-008-0632-x
        • Galasso O.
        • Jenny J.Y.
        • Saragaglia D.
        • Miehlke R.K.
        Full versus surface tibial baseplate cementation in total knee arthroplasty.
        Orthopedics. 2013; 36: e151-e158https://doi.org/10.3928/01477447-20130122-16
        • Kutzner I.
        • Hallan G.
        • Høl P.J.
        • Furnes O.
        • Gøthesen Ø.
        • Figved W.
        • et al.
        Early aseptic loosening of a mobile-bearing total knee replacement.
        Acta Orthop. 2018; 89: 77-83https://doi.org/10.1080/17453674.2017.1398012
        • Karter A.J.
        • Ferrara A.
        • Liu J.Y.
        • Moffet H.H.
        • Ackerson L.M.
        • Selby J.V.
        Ethnic disparities in diabetic complications in an insured population.
        JAMA. 2002; 287: 2519-2527
        • Koebnick C.
        • Langer-Gould A.M.
        • Gould M.K.
        • Chao C.R.
        • Iyer R.L.
        • Smith N.
        • et al.
        Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data.
        Perm J. 2012; 16: 37-41