Histology of the bone-cement interface in retrieved Oxford unicompartmental knee replacements

Radiolucent lines (RLL) are commonly seen at the cement–bone interface of knee replacements, yet are poorly understood. Although thin RLL are not associated with implant loosening or poor patient outcome there is still concern that they indicate sub-optimal fixation. The primary study aim is to characterise the histology at the cement–tibia interface in Oxford unicompartmental knee replacement (UKR). The second aim is to assess whether a correlation exists between the presence of a RLL and the type of tissue that predominates at the interface.

The radiology and histology of retrieved specimens of the interface from around firmly fixed tibial trays in ten patients undergoing revision between 1 and 19 years after Oxford UKR were studied.

Pre-revision radiographs showed the presence of both full and partial RLL. On contact radiographs of 5 mm thick sections of the interface the total percentage of radiolucency ranged from 0 to 90% between patients. There was no consistent pattern for the distribution of radiolucency. Histological assessment demonstrated that under every tibial component there were areas where there was direct contact and interdigitation between bone and cement. The amount of direct bone–cement contact was between 19% and 95% of the tibial tray surface area. The remaining tissue was mainly fibrocartilage but there was also fibrous tissue. The presence of radiolucency was strongly inversely correlated with the percentage of cement–bone contact.

This study demonstrates that even with partial or complete RLL seen on radiographs there is still cement–bone contact, thus indicating that there is stable fixation.