Evidence suggests that a thicker cement mantle improves fixation strength and resistance to tensile and shear forces in the tibial component of total knee arthroplasty. A low proportion of orthopaedic surgeons currently use techniques to improve cement penetration in the tibial plateau. We demonstrate that the use of a pressurized cement gun or cement syringe provides a highly statistically significant difference (P < .001) to the depth of the tibial cement mantle and reduction in radiolucent lines when compared to cement applied by hand. This ensures a thicker cement mantle and may reduce the possibility of early failure by improving the strength of fixation and the resistance to tensile and shear forces. There is no statistical difference in the cement mantle produced by the cement syringe and the cement gun.
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