Cement Mantle Thickness In Total Knee Arthroplasty More Closely Associated With Tibial Bone Density Than Cement Viscosity

Description

This episode of AI Talks with Bone & Joint discusses a 2026 paper by Y Mikashima and colleagues on cement mantle thickness in total knee arthroplasty. The hosts explain that the study aimed to compare the influence of tibial bone mineral density (BMD) and cement viscosity on cement mantle thickness. In a prospective randomized controlled trial involving 117 knees from 130 patients, participants received either medium-viscosity or high-viscosity cement, and mantle thickness was measured radiographically while tibial BMD was assessed using CT-based quantification. The main finding was a strong negative correlation between tibial BMD and cement mantle thickness in both groups, suggesting that bone density is more important than cement viscosity in determining mantle thickness. The authors identified a tibial BMD cutoff of 78.4 hydroxyapatite/cm³ to achieve a cement mantle thickness of at least 2.1 mm, a threshold associated with fewer radiolucent lines and better implant stability. High-viscosity cement produced greater thickness in central zones, but not peripheral zones. The discussion highlights practical implications, including considering alternative fixation strategies such as cementless fixation or enhanced drilling in patients with high BMD. Overall, the episode emphasizes the importance of preoperative tibial bone quality assessment to guide fixation choices and optimize total knee arthroplasty outcomes.

Specialties

Paper Links

https://boneandjoint.org.uk/Article/10.1302/2633-1462.74.BJO-2025-0348.R2