The Effect of Viscosity on Cement Penetration in Total Knee Arthroplasty, an Application of the Squeeze Film Effect

The authors present a prospective randomized blinded cadaver study designed to evaluate the engineering concept of a squeeze film effect and the effect of cement viscosity on cement penetration in total knee arthroplasty. This was done in response to an earlier clinical study demonstrating inferior tibial cement penetration using early, often liquid, phase cement. Paired cadaver tibias were implanted with the tibial component using either liquid or dough phase cement. Based on an AP fluoroscopic image, the dough phase cement penetrated deeper than liquid in all four zones. This was statistically significant in zones 1, 2 and 3. Deeper cement penetration has been shown to provide a stronger cement–bone interphase. As a result dough phase cement is recommended to obtain optimal cement penetration.