Revision surgery caused by knee replacement cement failure may be the result of defective bone cement used during knee replacement surgery.

During knee replacement surgery, the natural joint is replaced with an implant to mimic movement. Damaged bone is typically removed to make way for the implant, which is secured with screws and bone cement. Bone cement is not always used to attach an implant, but it is a common strategy.

There are three widely used types of bone cement used in total knee replacements: low viscosity bone cement, medium viscosity bone cement, and high viscosity bone cement. High viscosity bone cement may be preferred by surgeons because it taxes less time to mix and sets more quickly. However, it may result in knee replacement cement failure according to recent claims by researchers that the products fail to adhere to bone.

Knee replacement cement failure may cause a variety of side effects including aseptic loosening. Aseptic loosening typically occurs where an implant attaches to the tibia and involves the loosening of the implant without any accompanying infection. The side effect can occur due to fragmenting of the bone cement or because the bond between the bone and the cement is broken.

In 2016, a report was published by the National Center for Biotechnology Information (BNBI) investigating 13 cases of aseptic tibial loosening. The researchers in the report linked the tibial loosening of implants due to the usage of high viscosity bone cement. Implants which were attached using low or medium viscosity bone cements reportedly did not result in the debonding that was seen with high viscosity bone cement.

If implant loosening occurs, patients may have to undergo revision surgery. During revision surgery, a surgeon removes the previous implant and replaces it with a new implant. If bone and tissue have been damaged by knee replacement cement failure, the surgery may be longer and the surgeon may need to graft new bone to support the new implant.

According to the American Academy of Orthopedic Surgeons (AAOS), a variety of risks are associated with revision surgery including: poor wound healing; reduced range of motion or stiffness in the knee; infection in the wound or the new prosthesis; bleeding; blood clots; bone fracture during surgery, damage to nerves or blood vessels; pulmonary embolism—a blood clot in the lungs; and medical problems such as heart attack, lung complications, or stroke. Even after the surgery, it may take a long time for the body to recover from the intense surgery.

Multiple lawsuits have been filed regarding knee replacement cement failure. One knee replacement cement failure lawsuit was filed in June 2018 against a Johnson & Johnson subsidiary, alleging that the SmartSet HV Bone Cement’s defective nature caused implant failure only a year after initial knee replacement surgery.

Numerous high-viscosity bone cements are under investigation by attorneys, including: Cobalt HV Bone Cement (Biomet/DJO Surgical); DePuy CMW 1 Bone Cement (NOT CMW 2 or CMW 3); Simplex HV Bone Cement (Stryker/Howmedica); and SmartSet HV Bone Cement (DePuy).