{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T01:12:50Z","timestamp":1784250770371,"version":"3.55.0"},"reference-count":44,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T00:00:00Z","timestamp":1736899200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The aim of this multicenter study was to analyze the potential impact of patient demographics and cementation technique towards the development of radiolucent lines (RLLs) in primary total knee arthroplasty (TKA). It was hypothesized that cementation techniques, including higher cement volume, double\u2010layer cementation technique and hardening in full extension, reduce RLL incidence by improving stability, whereas demographic factors such as age, BMI and smoking may increase RLL risk by affecting bone quality and mechanical loading.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Altogether, 776 patients (median age: 70.7 years; 39.2% males) underwent TKA at five tertiary orthopaedic centres between 11\/2013 and 04\/2023. X\u2010rays were analyzed retrospectively for the evaluation of RLLs taken between 6 and 36 months from surgery. RLLs on anterior\u2013posterior and lateral X\u2010rays taken at a median of 14 months (range: 6\u201336) from primary surgery were evaluated using the Knee Society roentgenographic evaluation and scoring system. Potential associations of demographics and cementation technique on the occurrence of RLLs during follow\u2010up were analyzed with uni\u2010 and multivariate logistic regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall incidence of RLLs around the TKA amounted to 37.4% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009290), with the tibial component (29.4%) being more commonly affected than the femoral component (15.0%). Patient age, gender, BMI and smoking habits were not significantly associated with higher incidence of RLLs (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). The amount of cement used (odds ratio: 0.99; 95% confidence interval: 0.98\u20130.99;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028) was independently associated with a lower incidence of RLLs, irrespective of the double\u2010 versus single\u2010layer cementation technique, cement hardening in full extension and time required for the X\u2010ray.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>No influence of demographic data on the incidence of RLL was found, yet specific cementation techniques appeared beneficial. Future studies with longer follow\u2010up periods are required to provide further insight into the herein\u2010made preliminary findings and to assess potential associations with long\u2010term aseptic loosening rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, retrospective observational study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.12582","type":"journal-article","created":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T04:11:13Z","timestamp":1736914273000},"page":"2179-2186","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Higher bone cement volume in total knee arthroplasty lowers the risk of postoperative radiolucent lines"],"prefix":"10.1002","volume":"33","author":[{"given":"Maximilian","family":"Keintzel","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Trauma\u2010Surgery Medical University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1021-0899","authenticated-orcid":false,"given":"Maria A.","family":"Smolle","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Medical University of Graz Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Staats","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma\u2010Surgery Medical University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"B\u00f6hler","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma\u2010Surgery Medical University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinhard","family":"Windhager","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma\u2010Surgery Medical University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Koutp","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Medical University of Graz Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Leithner","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Medical University of Graz Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Donner","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin Berlin 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