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

Abstract

Background: Whether the cement could be given up in total knee arthroplasty (TKA) was still in controversy. We perform this meta-analysis to compare the rate of revision and functional recovery between two kinds of fixation in TKA. Methods: Randomized controlled trials (RCTs), prospective/retrospective observational studies from PubMed (on 2019 Sep), EMBASE (on 2019 Sep), and the Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science (on 2019 Sep) were searched. Continuous outcomes were presented as mean difference or standard mean difference with 95% CI and discontinuous outcomes were reported as relative risk (RR) with 95% CI. Random-effects or fixed-effects model was conducted to analyze the extracted data. The PRISMA guidelines and Cochrane Handbook were adopted to assess the quality of the results reported in included studies to ensure that the results of our meta-analysis were reliable and veritable. The continuous and dichotomous outcome were collected in a standard form, and the data were analysed by using Review Manager 5.3 software. Finally, the results were presented in the Forest plots. The rate of revision and reasons caused revision was the primary outcome of our study.Results: Twenty-six studies involving 2369 patients in cementless TKA and 2654 patients in cemented TKA were finally included in our meta-analysis. 26 studies were divided into three subgroups according to the length of follow-up. The studies in the first subgroup followed less than 5.5 years, the second followed less than 10.5 years, and the third followed more than 10.5 years. Cementless fixation significantly decreased the rate of aseptic loosing (p=0.0002) and revision (p=0.0002) in the first subgroup. Other reasons such as periprosthetic joint infection (PJI), instability and polyethylene wear were not significantly different between two groups. Significantly better functional recovery was got in cementless TKA in terms of Knee Society Function Score (p=0.01) when followed longer than 8.5 years. Significantly less patients in cementless group require manipulation under anesthesia (p=0.02) when duration was longer than 5.5 years. However, there was no significant difference regarding the rate of complication between two kinds of fixation in TKA.Conclusion: Not only the rate of aseptic loosing was decreased, rate of revision was also significantly decreased in cementless TKA within 5.5 years. In addition, the cementless TKA seemed performed better in postoperative functional recovery when had a long-term follow-up. However, the rate of complication was not significantly different in two kinds of fixation in TKA.