Cemented tibial tray fixation

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Total knee arthroplasty, despite being a successful surgical procedure, led to approximately 25,000 revision surgeries in Germany in 2013, primarily involving the tibial component of the prosthesis. To minimize the risks of infection and bone loss associated with implant removal, it is crucial to avoid or delay revision surgeries. Aseptic loosening, often due to inadequate implant fixation, is the reason for revision in up to one third of cases. Typically, fixation is achieved with bone cement that interlocks with trabecular bone, with pull-out strength serving as an indicator of fixation quality. This strength is linked to the cement's penetration depth into the bone. The trabecular bone's architecture, which varies by patient and location, may also influence fixation strength, necessitating patient-specific evaluations. This thesis aimed to enhance the interlock between cement and bone by examining cement layer morphology in cadaveric specimens. The study analyzed the effects of cement penetration depth, application techniques, and bone density and porosity on fixation strength through computed tomography, mechanical pull-out tests, and statistical modeling. Various cementation techniques, including gun and manual application, full and plateau-only cementation, two-layered cementation, and bone cleansing methods, were investigated.