Long-term survivorship of total knee replacement (TKR) relies on the periprosthetic bone strength and its initial fixation stability. Aseptic loosening caused by mechanical factors is a recognised failure mode for knee prostheses. Bone resorption due to “stress-shielding” of the stiff stemmed implants will potentially lead to weakened bone strength, and also presents a challenge for revision surgery. While the bone cement is commonly used to provide mechanical attachment of the prosthesis to the bone, cement fatigue and bone-cement interface failures would eventually lead to component migration and aseptic loosening of the tibial components. The cementless fixation relies on bony ingrowth into the porous surfaces of the prosthesis thereby providing a biological attachment. Its fixation strength would depend largely on the initial stability of the fixation, where excessive bone-prosthesis relative motion (>50μm) would inhibit the osseointegration process [1]. The above are caused partly by a lack of knowledge of the optimum implant design and fixation technique factors.

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