A Matched Comparison of the Long-Term Outcomes of Cemented and Cementless Total Knee Replacements

Abstract

Background: Total knee replacement (TKR) can be implanted with or without the use of cement. It is currently unknown how cemented and cementless TKRs compare overall and in different age groups of the population in the long term. Methods:The National Joint Registry collects information on knee replacements inserted in England, Wales, Northern Ireland and Isle of Man and was linked for multiple confounders to the National Health Service Hospital Episode Statistics database. Using propensity matched scoring techniques 44,954 cemented and cementless TKRs were compared. Regression models were used to compare the outcomes revision, two stage revision, reoperation and mortality both overall and in different age strata. Results:The 10 year implant survival (revision endpoint) for cemented and cementless TKRs were 96.0% and 95.5% (Hazard Ratio (HR) 1.14, p=0.01). The 10 reoperation endpoint was 82.7% and 81.4% respectively (HR 1.08, p=0.001). The rates of pain were higher in cementless TKRs (0.5% vs 0.7%, p=0.002) but the rates of infection were lower (0.7% vs 0.5%, p=0.003). No significant interactions with age existed for outcomes of; revision (p=0.24), reoperation (p=0.30) or mortality (p=0.58). Conclusions:We found that matched cemented and cementless TKRs both have 10 year implant survivals over 95%. Cementless TKRs had a higher absolute difference in revision rates (0.5%) and reoperation rates (1.3%). The rates of revision for infection were lower in the cementless group, although rates of revision for pain were higher. Age did not significantly affect the relative performances.

Cementless Versus Cemented Total Knee Arthroplasty of the Same Design: Shorter Operative Times and Minimal Differences in Early Outcomes

“…Similarly, a multicenter study of 605 cementless and 605 cemented Stryker TKAs by Yazdi et al [20] showed no difference in reoperation rates and higher rates of aseptic revision rates in the cementless (1.2%) versus the cemented (0.8%) cohort ( P = .294). However, several registry studies have reported a 1% to 2% higher rate of early failure of cementless TKAs compared with cemented TKAs due to fracture or failure of bony ingrowth, similar to our findings [12,15,18]. In the cementless cohort, 2 patients (1.2%) underwent early revision for aseptic loosening compared with none in the cemented cohort.…”

“…However, the advent of porous metal ingrowth surfaces that use 3-dimensional printing and manufacturing holds the promise of improved biologic fixation and has renewed interest in cementless implants [2,3,17,19]. Registry data from the United Kingdom suggested improved 10-year survivorship with cementless TKA, albeit with slightly higher revision rates compared with cemented TKA [12].…”

The Effect of Body Mass Index on the Relative Revision Rates of Cemented and Cementless Unicompartmental Knee Replacements

“…Factors used for matching included BMI, age, sex, Charlson comorbidity index, American Society of Anesthesiologists (ASA) grade, year of surgery, bone graft usage, surgical indication, venous thromboembolism (VTE) prophylaxis, ethnicity, rural/urban location, admission type, deprivation indices, and UKR surgeon caseload. Surgeon caseload was defined as the mean number of UKRs performed per year as described previously 29,30 .…”

Modern cementless posterior stabilized mobile-bearing total knee arthroplasty shows comparable clinical and radiographical results to its cemented predecessor at 1-year follow-up

“…Thus, there are continued interests in cementless TKA for biological ixation. Recent systematic reviews and meta-analyses show that cementless TKA had implant survivorship comparable to cemented TKA [7,10,20,21,33]. Concerning radiographical results of cementless TKAs, Hasan et al and Sporer et al noted that tibial migrations were largest within the irst six weeks and three months postoperatively, respectively, and further migrations had not appeared at 2 years postoperatively [13,30].…”