title: The effect of multiple drilling on a sclerotic proximal tibia during total knee arthroplasty.
abstract: OBJECTIVE
  To assess the depth of cement penetration and the occurrence of radiolucent line (RLL) according to drill bit diameter used in multiple drilling for the sclerotic bone of the medial proximal tibia during total knee arthroplasty (TKA).
  
  
  METHODS
  The multiple drilling procedure was performed with 2.0 mm diameter in group 1 (n = 290) and with 4.5 mm diameter in group 2 (n = 109) to enhance the cement penetration. The postoperative RLL in the cement-bone interface and the depth of cement penetration were measured under the tibial implant at three, six, 12 and 24 months after TKA. The progression of RLL was also evaluated at the latest follow-up.
  
  
  RESULTS
  Cumulative occurrence rates of RLLs were significantly lower in group 2 than in group 1 at 12 and 24 months postoperatively (P = 0.005 and 0.004). The depth or width was increased in nine cases only in group 1 at the latest follow up. There was no tibial implant loosening in both groups at the latest follow-up. Mean maximal depths of cement penetration were 1.1 mm in group 1 and 4.8 mm in group 2 at three months (P < 0.001).
  
  
  CONCLUSIONS
  Our comparative study between the different diameters used during multiple drilling for the tibial sclerotic surface suggests that a multiple drilling technique with a larger diameter of 4.5 mm can improve the depth of cement penetration and reduce the occurrence rate of RLLs after TKAs.
authors.affiliation: Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Seoul, South Korea, drsky71@duih.org.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Ahn
authors.forename: Seung Hyo
authors.initials: SH
authors.lastname: Jeong
authors.forename: Sung Hyun
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001843:Bone Cements / Q000009:adverse effects*; D002484:Cementation / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D001843:Bone Cements