Case series report: Early cement-implant interface fixation failure in total knee replacement

•A case series of early total knee failure due to aseptic loosening is reported.•Nine failures were observed over a 5-year period by an uncommon mechanism.•The mechanism of failure was due to cement fixation de-bonding at the cement-implant interface.•A common element among these early total knee failures was the use of high-viscosity cement.•Use of HVC may be related to failure at the cement-implant interface and aseptic loosening.

BackgroundEarly failure in cemented total knee replacement (TKR) due to aseptic loosening is uncommon. A small number of early failures requiring revision were observed at one hospital due to observed cement-implant fixation failure. The purpose of this case series is to report and identify possible causes for these early failures.MethodsBetween May 2005 and December 2010, 3048 primary TKRs were performed over a five-year period of time by six surgeons. Two total knee systems were used during this period of time. Nine early failures were observed in eight patients. High viscosity cement (HVC) was used in all these cases.ResultsAseptic loosening of the tibial component was observed in all nine early total knee failures. The high viscosity bone cement was noted to be non-adherent to the tibial trays at the time of revision surgery. HVC was used in all these cases.ConclusionsProperties of HVC may contribute to make it more susceptible to early failure in a small number of TKRs. HVC in total hip replacement (THR) has been associated with cement micro-fractures, cement debris generation and early implant failure. The mechanical properties of HVC may similarly contribute to early failure at the cement-implant interface in a small percentage TKRs.