A clinical and radiographic analysis of loosening of total knee arthroplasty components using a bilateral model

Patients undergoing bilateral, simultaneous total knee replacement provide a unique opportunity to study the role of operative techniques in the development of radiolucent lines because variables such as age, sex, weight, diagnosis, and bone quality are internally matched when the result on one side is compared with that of the other. This allows more conclusive examination of operative factors, such as component alignment, level of tibial bone resection, and cement handling. With this as the objective, the clinical and radiographic results of the first 50 bilateral total knee replacements performed by the senior author were studied. Postoperative alignment was found to influence significantly the incidence of tibial radiolucent lines. Use of cement to reconstruct defects in the proximal tibia resulting from preoperative deformity consistently led to the development of radiolucent lines in the area of the defect. There was also indirect evidence that failure to achieve an intimate microinterlock at the bone-cement interface may play a major role in the development of tibial radiolucent lines.