Loosening of prosthetic components continues to play a large role in total knee alloplasty (TKA) and need for revision. Osteolysis is an important part of prosthesis loosening, but we still do not completely understand the mechanism. Research has shown that mechanical factors such as weak bone cement and poor contact between cement/bone or cement/implant interphase contribute to loosening of implants. Survival of cemented TKA components also depend on a careful balancing of soft tissues around the knee, repair of lower extremity dislocations, design of the prosthesis and the level of patients' activities. Sclerosis of the proximal tibia can present a problem with regard to getting the cement to penetrate into the bone. Poor operative technique, such as high volume or high pressure lavage of the prepared bone surface, can result in reduced penetration of cement into the spongiosa and early failure of the prosthesis, measured as progressive radiolucent lines (RLLs). En tourniquet counter acts bleeding at the implant site and provides for better penetration of cement into the trabeculae of the bone. If the bone surface at the implantation site is contaminated with blood before the cement is applied, the shear strength in the bone/cement interphase can be reduced by up to 50%.