The use of cement in revision total knee arthroplasty.

Despite the availability of modern implants and techniques, Revision Total Knee Arthroplasty (R-TKA) still poses a challenge to surgeons, particularly the management of bone loss/defects and the secure fixation of implants. Polymethylmethacrylate (PMMA) bone cement plays an important role for fixation as fully uncemented fixation in RTKA is rarely used. Cement can be employed as part of a full cementing construct or as a hybrid construct. While in fully cemented implants, the diaphyseal stem as well as any couplers or connectors in the metaphysis are cemented, in hybrid cementing, only the component parts at the joint surface and metaphysis are cemented, while the diaphyseal stem is fixed in a press-fit manner. In this article the literature on the in vitro as well on the in vivo results of both fixation options is reviewed. Although the fixation mechanism of both constructs are different, radiographic and clinical survivorship appear similar for both techniques. Although there appears to be a trend towards a hybrid fixation method, the choice of which technique to employ in revision total knee arthroplasty will depend on the surgeons' familiarity with each technique as well as the factors peculiar to each patients anatomy.