Aseptic tibial loosening is the number 1 cause of failure leading to revision after total knee arthroplasty (TKA). That shouldn’t be the case: At the 7th Annual ICJR South Hip & Knee Course, Daniel J. Berry, MD, from Mayo Clinic in Rochester, Minnesota, said that surgeons know more now about how to cement knee implants than they did even 15 years ago and have – theoretically – gotten better at it.