Primary Total Knee Arthroplasty Performed Using High-Viscosity Cement is Associated With Higher Odds of Revision for Aseptic Loosening

Aseptic loosening (AL) is the most common reason for revision total knee arthroplasty (TKA). An association between high-viscosity cement (HVC) and AL has been suggested by small, uncontrolled, case series. This study sought to determine whether HVC use during primary TKA is independently associated with AL requiring revision.

We retrospectively analyzed a prospectively collected institutional knee registry to identify all primary TKAs from January 2007 to December 2016. Patients with less than 2 years of follow-up were excluded. Cement type was divided into 2 groups: HVC and low-viscosity cement. Potential confounders including age, body mass index, preoperative diagnosis, antibiotics in the cement, and implant type were recorded. Multivariable logistic regression analysis was used to determine whether HVC is independently associated with revision for AL.

In total, 10,014 patients were included. Revision for AL was significantly higher in the HVC cohort (91/4790; 1.9%) vs the low-viscosity cement cohort (48/5224; 0.92%) ( P < .001). Logistic regression demonstrated HVC to be independently associated with higher odds of revision for AL (odds ratio 2.26, 95% confidence interval 1.58-3.22, P < .001). Younger age was also associated with higher odds of revision for AL (odds ratio 0.96, 95% confidence interval 0.94-0.98, P < .001). Body mass index, gender, laterality, preoperative diagnosis, and antibiotics in the cement were not associated with revision for AL. Implant manufacturer, implant design, and cement brand all impacted the odds of undergoing revision for AL.

Although HVC is an attractive option for use in primary TKA, this appropriately controlled study demonstrates higher odds of revision for AL when using HVC with multiple different implant types.