Cemented Versus Cementless Total Knee Arthroplasty of the Same Modern Design

Abstract

Background: Highly porous surfaces promoting biologic fixation have renewed interest in cementless total knee arthroplasty (TKA), but the potential for failed biologic fixation remains. The purpose of this study was to compare the clinical outcomes of cemented and cementless versions of the same TKA design at an average of 2 years postoperatively. Methods: This was an institutional review board-approved, prospective, randomized controlled trial of patients from 18 to 75 years of age who were undergoing a primary TKA. Patients with inflammatory arthritis, a body mass index (BMI) of >40 kg/m 2 , infection, a neuromuscular disorder, or grossly osteoporotic bone or bone defects were excluded. Patients were randomized to receive a cemented or cementless cruciate-retaining TKA of the same design. The cementless implant has highly porous fixation surfaces. Oxford Knee, Knee Society, and Forgotten Joint Scores were collected. Patients were asked to rate the knee with the TKA as a percentage of normal. Power analysis indicated that 130 patients were necessary to demonstrate a 5-point difference in the Oxford Knee Score at 90% power. Results: One hundred and forty-seven patients were enrolled, and 141 (96%) of them were analyzed at an average of 2 years postoperatively. There was no difference in age, sex, BMI, American Society of Anesthesiologists (ASA) score, or duration of follow-up (p = 0.1 to 0.9). There was also no difference in the change in the hemoglobin level from the preoperative measurement to postoperative day 1 between the 2 cohorts (mean and standard deviation, −2.6 ± 1.4 g/dL compared with −2.5 ± 0.9 g/dL, p = 0.5), but the total operative time was decreased in the cementless cohort (82.1 ± 16.6 compared with 93.7 ± 16.7 minutes, p = 0.001). There were no differences in any clinical outcome measure at 4 to 6 weeks, 1 year, or an average of 2 years postoperatively (p = 0.1 to 0.9) between the cemented and cementless cohorts. There was no radiographic evidence of component subsidence or loosening in either cohort. Conclusions: This study demonstrated that a recently introduced cementless TKA had results, both perioperatively and at an average of 2 years postoperatively, that were equivalent to those of its cemented predecessor, without any aseptic failures of either implant. Thus, this study justifies continued surveillance of this device to elucidate both its survivorship and if it can provide any long-term benefits. Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Learning Curve of Robotic-Assisted Total Knee Arthroplasty for a High-Volume Surgeon

“…However, in a recently published study, mean operative time for cemented TKA cases was 82.1 AE 16.6 minutes compared with 93.7 AE 16.7 minutes in cementless cases. 15 This accounted for an 11 minutes increase with a large standard deviation in operative time. Therefore, the large decrease in the current study was not only due to using cementless components but also due to experience with the roboticassisted technology.…”

Improved survival rate and functional recovery of TKA in cementless fixation compared with cemented component: a systematic review and meta-analysis

“…The JADAD score of 11 RCTs were listed in Table 2, both of them were ≧5, four of them [2,15,21,22] got 7 points. The MINORS scores of 15 non-RCTs were listed in Table 3, both of them were ≧20, only one of them [37] got 24 points.…”

“…RCTs[2,[13][14][15][16][17][18][19][20][21][22]and 15 non-RCTs[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] were included in this study after meeting the inclusion and exclusion criteria.Baseline information and quality assessment 26 studies involving 2369 patients in cementless group and 2654 patients in cemented group were divided into three subgroups according to the length of follow-up. The length of follow-up ≤5.5 years including 17 studies [14-18,20,21,23-25,27,29,31,32,35-37], which ranged from 2 to 5.3 years.…”

Cemented versus uncemented total knee arthroplasty in younger patients

“…However, observed signs of osteolysis at the cement-bone interface have raised questions about the long-term durability of cemented TKAs in younger patients. [ 12 , 13 ] Cementless TKAs have been developed in an attempt to improve the longevity of implants, particularly in younger patients. It is thought that a more physiological bond between bone and implant would result in improved survival from aseptic loosening.…”