Cementation of Tibial Inserts Into Nonmatching Base Plates in Revision Total Knee Arthroplasty

We describe the use of a novel technique for adapting nonmatching tibial inserts into tibial trays in revision total knee arthroplasty. From 1998 to 2003, the senior author performed 7 revision total knee arthroplasty procedures, during which a nonmatching tibial insert was cemented into a tibial tray to retain a well-fixed but incompatible opposite component. Bench tests were undertaken to confirm the stability of cement as a locking mechanism substitute. Three components completed 1 000 000 cycles of loading under simulated physiologic stresses with no evidence of fixation failure. There have been no clinical failures at 18 to 69 months in vivo follow-up (mean, 49 months). This technique provided durable fixation while avoiding host bone damage that might have occurred needlessly had the well-fixed implant been extracted. Level of evidence: level IV therapeutic study, case series.