Cementless Fixation for Total Knee Arthroplasty in Various Patient Populations: A Literature Review

Abstract

The number of total knee arthroplasties (TKAs) performed in the United States has increased considerably in recent years, with a major contribution from younger patients. Maximizing survivorship of these implants has always been a point of emphasis. Early TKA designs with cementless fixation were associated with high rates of complications and implant failures. However, recent advances in cementless designs have shown excellent results. The decision to use cemented or cementless fixation for patients undergoing TKA is typically based on the surgeon's experience and preference. However, several patient characteristics must also be taken into account. The purpose of this review was to describe the clinical outcomes of studies in which a cementless TKA system was utilized for patients who (1) were less than 60 years of age, (2) were greater than 75 years of age, (3) were obese, (4) had rheumatoid arthritis, and (5) had osteonecrosis of the knee. Based on the studies included in this review, it appears that cementless fixation is a viable option for patients who have all of the above demographics.

Cementless Total Knee Arthroplasty

“…The interest in cementless fixation is highly related to the elevated failure rate of cement in some patient groups 88 , but there are still concerns about early loosening of press-fit implants 76 . Appropriate patient selection and meticulous surgical execution are essential in the cementless technique, to minimize this risk 24 .…”

Highlighting the advantages and benefits of cementless total knee arthroplasty (Review)

“…New improvements in implant models, materials and surgical techniques have enhanced the implant survival rates in contrast to earlier models, reaching a survival rate of 96-100% after 10-15 years (38,39). For cemented as well as cementless procedures, UKA has demonstrated better functional results as compared to TKA (40).…”

The influence of body weight index on initial stability of uncemented femoral knee protheses: A finite element study

“…Sinicrope et al found that high-BMI patients receiving uncemented TKA had a lower rate of aseptic loosening at 8 years compared to patients receiving cemented TKA (99.1% vs. 88.2%) [ 19 ]. This may be a result of the long-term biological fixation of uncemented prostheses [ 20 ]. Despite these encouraging results from comparative studies, the effect of increasing BMI on the survivorship of uncemented prostheses remains unknown.…”