Tibial component in total knee arthroplasty: To cement or not to cement?

Loosening of the tibial component is a major cause of failure in total knee arthroplasty. Implant stability is a key element for achieving long term successful results and relies on the interplay of several factors which include the method of fixation, prosthesis design, surgical technique, bone quality and patient characteristics.The analysis of these aspects may provide some guidelines for the choice of fixation, but an ultimate solution of the problem can not be found in the past experience with total knee replacement. A better understanding of the biological and mechanical changes induced in bone tissue by the joint disease as well as by the prosthesis, will probably allow us to adopt the most appropriate solution for every patient.