Cementless unicompartmental knee replacement achieves better ten-year clinical outcomes than cemented: a systematic review

Mohammad, Hasan R; Bullock, Garrett S.; Kennedy, James A.; Mellon, Stephen; Murray, David; Judge, Andrew

doi:10.1007/s00167-020-06091-5

Cited by 24 publications

(17 citation statements)

References 68 publications

(172 reference statements)

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“…In addition, a recent level III systematic review evaluated the effect of cementing in 10,736 UKAs and found that cementless UKA was associated with lower revision rate than the cemented UKA (0.45% pa vs 0.73% per annum , p < 0.001). However, this difference was insignificant ( p = 0.41) in the non-Oxford UKAs with similar revision rates of cemented and cementless UKRs (0.57% pa vs 0.69% pa) [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of age on unicompartmental knee arthroplasty outcomes: a systematic review and meta-analysis

Salman

Abudalou

Khatkar

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Unicompartmental knee arthroplasty (UKA) is an effective treatment for late knee osteoarthritis (OA). Young age (< 60 years) has been associated with worse outcomes. The goal of this systematic review and meta-analysis is to study the effect of age on UKA outcomes. Methods The primary objective was to compare the UKA revision rate in young patients with that of old patients, using the age thresholds of 60 and 55 years. Secondary objectives were patient-reported outcome measures (PROMs) and implant design. Five databases were searched in December 2021 for original comparative studies with a minimum of 1-year follow-up. No restrictions were placed on the type of UKA prosthesis. Results A total of 11 observational studies with 6130 knees were included. A mean MINORS score of 19 was assigned to the review. The mean age of patients was 64 years, with average follow-up of 7.5 ± 2.98 years. There was no significant difference in revision rate, incident or PROMs between young and old patients in the analysis for each age threshold. Further sub-analysis adjusting for implant type in mobile- and fixed-bearing prostheses also showed similar results between those above and under 60 and 55 years. Conclusion Young age was not associated with a higher revision rate or lower functional scores. Thus, this review provides evidence that age alone is not a contraindication to UKA, but the surgical choice must be based on several elements, and this finding should be applied in context, given the binary division and heterogeneity of patients. Level of evidence III.

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Section: Discussionmentioning

confidence: 99%

Impact of age on unicompartmental knee arthroplasty outcomes: a systematic review and meta-analysis

Salman

Abudalou

Khatkar

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…Similar excellent mid- to long-term results are shown in a number of other recent studies on cementless UKA. 9 , 38 , 39 …”

Section: Uka Outcomesmentioning

confidence: 99%

“…Mohammad et al 9 undertook a pooled analysis of 8,760 cemented and 1,946 cementless UKAs, and reported ten-year survivorship was 92.7% and 95.5%, respectively (p < 0.001). The authors reported improved revision rates in cementless mobile-bearing UKAs relative to cemented, but consistent revision rates among fixed-bearing UKAs regardless of cementation group.…”

Section: Uka Outcomesmentioning

confidence: 99%

“… 7 These advantages have led to a number of high-volume centres selecting cementless over cemented UKA, 1 , 8 with excellent patient-reported outcomes and implant survivorship of over 97% at minimum ten years follow-up. 9 , 10 Over the last decade, evolution of implant design and materials have enabled TKA to follow a similar trend to UKA.…”

Section: Introductionmentioning

confidence: 99%

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Cementless knee arthroplasty: a review of recent performance

et al. 2021

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Cementless knee arthroplasty has seen a recent resurgence in popularity due to conceptual advantages, including improved osseointegration providing biological fixation, increased surgical efficiency, and reduced systemic complications associated with cement impaction and wear from cement debris. Increasingly younger and higher demand patients are requiring knee arthroplasty, and as such, there is optimism cementless fixation may improve implant survivorship and functional outcomes. Compared to cemented implants, the National Joint Registry (NJR) currently reports higher revision rates in cementless total knee arthroplasty (TKA), but lower in unicompartmental knee arthroplasty (UKA). However, recent studies are beginning to show excellent outcomes with cementless implants, particularly with UKA which has shown superior performance to cemented varieties. Cementless TKA has yet to show long-term benefit, and currently performs equivalently to cemented in short- to medium-term cohort studies. However, with novel concepts including 3D-printed coatings, robotic-assisted surgery, radiostereometric analysis, and kinematic or functional knee alignment principles, it is hoped they may help improve the outcomes of cementless TKA in the long-term. In addition, though cementless implant costs remain higher due to novel implant coatings, it is speculated cost-effectiveness can be achieved through greater surgical efficiency and potential reduction in revision costs. There is paucity of level one data on long-term outcomes between fixation methods and the cost-effectiveness of modern cementless knee arthroplasty. This review explores recent literature on cementless knee arthroplasty, with regards to clinical outcomes, implant survivorship, complications, and cost-effectiveness; providing a concise update to assist clinicians on implant choice. Cite this article: Bone Jt Open 2021;2(1):48–57.

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“…This conclusion was also reflected in other recent findings. For example, Mohammad et al [ 14 ] found lower long-term revision rates for cementless UKA compared with cemented UKA and positive results for cementless UKA for all age groups [ 15 ]. Basso and colleagues [ 5 ] reported that using a cementless fixation could possibly improve survival rate by reducing problems associated with the cement, such as inappropriate penetration and loose fragments.…”

Section: Introductionmentioning

confidence: 99%

Cementless unicompartmental knee arthroplasty results in higher pain levels compared to the cemented technique: a prospective register study

Gifstad¹,

Nordskar²,

Egeberg³

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose In recent years, the preferred fixation method for unicompartmental knee arthroplasty (UKA) has changed from cemented to cementless. The aim of this study was to compare patient-reported outcome measures (PROMs) from the cemented versus cementless techniques two- and twelve-months post-operation. Methods From 2015 to 2019, 187 cemented and 261 cementless UKAs were included based on an institutional registry. The Oxford Unicompartmental Knee System™ (Zimmer Biomet, Bridgend, United Kingdom) was used for all patients. Three experienced surgeons performed all procedures. Data were collected pre- and peroperatively, and at two- and twelve-months postoperatively. PROMs included pain (evaluated on a numeric rating scale [NRS] during activity and at rest), and knee function (evaluated with the disease-specific short form of the Knee injury and Osteoarthritis Outcome Score [KOOS-PS]). Patients also rated postoperative joint function (better, unchanged, uncertain or worse) and were asked, “based on your experience to date, would you go through the surgery again?”. Duration of surgery was noted and revisions during the first post-operative year were evaluated. Results The cemented group reported significantly lower activity-related pain at both two- and twelve-month follow-up. This was also the case for pain at rest at twelve-month follow-up, and KOOS-PS at two-month follow-up. Duration of surgery (adjusted for surgeon differences) was eight minutes less on average with the cementless technique. Eleven prosthetic joint infections (PJIs) were found following the cementless fixation technique compared to three using the cemented implant. Conclusion UKA cases with cemented implants had lower pain scores during activity two and twelve months after surgery compared with those who had cementless implants. Differences in favor of the cemented group were also found for pain at rest one year after surgery and for KOOS-PS two months after. Surgery was significantly shorter in duration in the cementless group, but a relatively high number of PJIs were found in that same group. Level of evidence Level II.

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Cementless unicompartmental knee replacement achieves better ten-year clinical outcomes than cemented: a systematic review

Cited by 24 publications

References 68 publications

Impact of age on unicompartmental knee arthroplasty outcomes: a systematic review and meta-analysis

Impact of age on unicompartmental knee arthroplasty outcomes: a systematic review and meta-analysis

Cementless knee arthroplasty: a review of recent performance

Cementless unicompartmental knee arthroplasty results in higher pain levels compared to the cemented technique: a prospective register study

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