Relationship between cement penetration and incidence of a radiolucent line around the tibia 2 years after total knee arthroplasty: A retrospective study
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Abstract
Objectives
Cement penetration (CP) plays a key role in implant stability for cemented total knee arthroplasty (TKA), and the radiolucent line (RLL) >2 mm is a preliminary sign for loosening of components. However, the direct relationship between CP and the frequency of RLL >2 mm is unclear, and the best cut-off value for CP to prevent RLL >2 mm also remains unclear. This study aimed to investigate this relationship between CP and RLL and to determine the clinical cut-off value for tibial CP in patients 2 years after TKA.
Methods
This retrospective study investigated 157 knees from 123 patients with osteoarthritis who underwent cemented TKA. The CP and RLL immediately after TKA and the RLL 2 years after TKA were measured for the medial, lateral, anterior, and posterior tibial baseplate zones. Receiver operating characteristic (ROC) curves were constructed to determine the best cut-off values for CP.
Results
RLL >2 mm was not observed just after TKA. An RLL >2 mm was observed in any tibial baseplate zone in 22 knees from 20 patients (RLL+ group) and was not observed in the remaining (RLL− group) 2 years after TKA. The mean CP for all zones was significantly higher in the RLL− group (2.5 ± 1.1 mm) than in the RLL+ group (1.7 ± 0.6 mm; P < 0.001). An RLL >2 mm was seen in 21 knees in the medial zone, 9 knees in the lateral zone, 8 knees in the anterior zone, and 3 knees in the posterior zone. CP values with RLL >2 mm were significantly lower than those without the RLL at the medial, anterior, and posterior tibial baseplate zones. The best cut-off values from the ROC curve of CP in each zone were between 1.1 mm and 2.1 mm.
Conclusions
The depth of the CP directly affects the incidence of an RLL >2 mm. The best cut-off value for tibial CP to prevent an RLL >2 mm is 2.1 mm.
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