Background: Aseptic loosening of the tibial component is the one of the commonest cause of failure following a TKR. Good cement penetration into bone can reduce this and this has led to the development of new devices and techniques to improve the pressurisation during the cementing process.

We have conducted a case controlled study on a novel cementing technique and compared the results with published optimum levels.

Methods: 104 patients that underwent TKR at our institution were studied. Half of these were cemented using a double mix of cement inserted under pressure via an inexpensive alternative to the cement gun. The data was collected prospectively and included patient information, knee outcome scores and radiological assessment and there was a minimum 4 years follow-up.

Results: We found a significant difference in the number of early lucent lines as well as the size of the cement mantle particularly in the most important Zones. Despite pressurisation 1 of the 14 zones did not improve and we have examined the reasons for this.

In order to achieve optimum cement penetration we recommend that attention is paid to good pressurization and cement penetration and describe our technique for doing this.