Knee replacement cement failure can lead to severe pain and complications which may require revision surgery to correct.

When a surgeon replaces the existing knee joint during knee replacement surgery, they have two options: use a cemented joint prosthesis or a cementless joint prosthesis.

As the name suggests, cemented implants use a fast-drying bone cement to attach the implant to the joint, while cementless implants often implement special textures which allow the bone to adhere to it through the healing process. Problems with knee replacement cement failure have been recorded, however.

There are positives and negatives to each type of implant, and the best choice will likely depend on many factors including patient physiology, type of surgery, and surgeon’s preference.

Cementless prosthesis, which is sometimes called press-fit implants, use a rough or porous surface which allows the bone to grow onto throughout the healing process. During the healing process, new bone typically only spans one or two millimeters. This means that the natural bone needs to fit snugly against the prosthesis so that the bone can properly adhere to the implant. Some cementless implants utilize screws or pegs to hold the device in place while waiting for new bone growth to securely attach.

As with any medical device, there are positives and negatives associated with cementless implants. Some surgeons prefer these implants because they believe the long term results are better and the implants reduce concerns about knee replacement cement failure.

However, cementless implants may not be a good idea for everyone. They require healthy bone, which means that patients with certain bone conditions are ineligible for these implants. Additionally, new bone growth takes up to three months which may affect the healing process.

On the other side of the spectrum, cemented prostheses require surgical cement to attach an implant to the natural bone. These implants do not rely on bone growth to attach the device to the bone and instead create a bond through cement instead.

Advantages of cemented prostheses include their ability to be used in patients with osteoporosis, the fact that antibiotic material can be added to surgical cement to prevent infection, and the quick drying time of cement providing confidence in the bond.

However, one of the largest risks of cemented implants is knee replacement cement failure. If the cement breaks down for any reason, it can lead to a loosening of the implant. This may require revision surgery to correct, which carries more risks than traditional knee replacement surgery. Knee replacement cement failure may also release cement debris into the tissue surrounding the joint, leading to inflammation and pain.

Additionally, cement used in knee replacement may enter the bloodstream which can lead to a life-threatening condition. This risk is highest for those who undergo spinal surgeries but can occur with knee replacement cement failure. Other serious risks include a serious allergic reaction to the bone cement which requires revision surgery to remove the cement.

It is unknown how often knee replacement cement failure occurs and why it occurs in some patients rather than others. Some researchers hypothesize that the type of bone cement used during surgery may lead to complications.