Cementless total knee arthroplasty

Abstract

As the number of younger and more active patients treated with total knee arthroplasty (TKA) continues to increase, consideration of better fixation as a means of improving implant longevity is required. Cemented TKA remains the reference standard with the largest body of evidence and the longest follow-up to support its use. However, cementless TKA, may offer the opportunity of a more bone-sparing procedure with long lasting biological fixation to the bone. We undertook a review of the literature examining advances of cementless TKA and the reported results. Cite this article: Bone Joint J 2016;98-B:867-73.

Postoperative Infection in Cementless and Cemented Total Knee Arthroplasty: A Propensity Score Matched Analysis

“…The ongoing debate on fixation modality for primary TKA is becoming increasingly relevant, especially with the increased use in younger patients and the advent of novel cementless prostheses. [1][2][3][4] Newer cementless implants have shown favorable outcomes and survivorship, particularly in patients with adequate bone stock and high metabolic activity. [8][9][10] However, few studies have investigated the effect of cementless fixation on postoperative infection rates.…”

“…The ideal mode of fixation in total knee arthroplasty (TKA) has been widely debated in the orthopaedic literature. [1][2][3][4][5] Although cemented fixation is more commonly used in TKA, it has previously been associated with osteolysis and loosening as a result of issues arising at the bone-cement interface. [6][7][8] These issues have been found to be more pronounced in the younger, more active subset of the patient population.…”

“…[9][10][11][12][13] More recently, newer cementless options have been developed to enhance osseointegration and are being increasingly used in younger patients who have adequate bone quality and active bone metabolism. [2][3][4]10,[12][13][14][15] Unlike their earlier counterparts, modern cementless prostheses have been shown to be comparable to cemented designs with regards to survivorship and functional outcomes. 12,[16][17][18][19][20] However, what has not been well-assessed is whether the two fixation modalities differ with respect to postoperative infection rates.…”

“…Literature on early cementless designs does not show favorable outcomes: however, many of the design flaws have since been studied and potentially improved upon. [2][3][4][5]24 Therefore, there is a need for comparative data on specific postoperative outcomes and complications with current designs. The purpose of this study was to assess the differences in postoperative infection rates after cementless and cemented procedures.…”

Survivorship and Functional Outcomes of Cementless versus Cemented Total Knee Arthroplasty: A Meta-Analysis

“…12,13 To decrease the failures related to cemented implants, cementless TKA fixation was developed to potentially increase implant survivorship and preserve bone stock. 5,[14][15][16] The original cementless implants, however, were associated with aseptic loosening and osteolysis that resulted in high early failure rates. [17][18][19][20] Despite these early problems, innovations in biomaterials and implant design have led to improved osseointegration and implant fixation, which could potentially improve cementless TKA long-term survivorship.…”