Gun pressurization in total knee arthroplasty (TKA) may result in better cement penetration than hand packing, leading to fewer tibial plate failures. We compared cement intrusion characteristics between vacuum mixing and gun pressurization versus hand mixing and packing in the proximal tibia among patients undergoing TKA.We analyzed 6-week radiographs from 77 consecutive patients for cement area and zone-specific intrusion using computer-assisted image analysis.Penetration into tibial anteroposterior zones 1-6 was not significantly different between the techniques. Intrusion depths in anteroposterior zone 7 and lateral zone 2 were significantly increased with gun pressurization, but this increase was associated with significantly longer operating room and tourniquet times.We identified no obvious advantage of vacuum mixing with gun pressurization, suggesting that continued use of the hand-packing technique may be warranted. Additional long-term failure studies must be completed to compare these techniques.