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.
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