Short-Term Outcomes Following Cemented Versus Cementless Robotic-Assisted Total Knee Arthroplasty

Abstract

Background: Cemented fixation during total knee arthroplasty (TKA) has long been the gold standard due to excellent survivorship and clinical outcomes. With recent biomaterial advancements, cementless fixation has gained renewed interest. Most studies demonstrate similar clinical outcomes and survivorship between these two fixation methods, without consensus regarding the optimal method of fixation during TKA. Outcomes following TKA also depend upon the proper alignment and positioning of components. Robotic-assisted TKA has been shown to improve outcomes related to component positioning, overall lower limb alignment, and soft tissue balancing. No study to date has investigated the role of roboticassisted surgery on postoperative outcomes following cementless versus cemented TKA.Methods: This is a retrospective cohort study of patients 18 years of age and older who underwent primary robotic-assisted TKA performed by a single fellowship-trained arthroplasty surgeon. Oxford Knee Scores and Short Form Health Survey scores were obtained preoperatively and at a two-year follow-up. Complications such as DVT, infection, arthrofibrosis requiring manipulation, and revision surgery were collected.Results: Three hundred eighty knees in the cementless cohort and 72 cemented knees were included for analysis. There were no statistically significant differences between the two cohorts in terms of SF-12, Oxford Knee Scores, complications, or revision surgery rates. Conclusion: Cementless fixation during TKA offers an alternative to cemented fixation with similar shortterm results in terms of patient-reported outcomes, complication rates, and revision surgery rates. Further research is warranted to better understand long-term outcomes and survivorship following cementless versus cemented fixation during robotic-assisted TKA.

Cemented vs Cementless Robotic-Assisted Total Knee Arthroplasty Yield Similar Short-Term Clinical Outcomes

“…In our retrospective cohort, we found that the cemented group had a higher rate of return to the operating room than the cementless group (1.8% vs 3.3%). This differs from the single surgeon study by McCormick et al., which found no differences [ 23 ]. The most common indication for return to the operating room in both groups was MUA for stiffness.…”

“…Surprisingly, we found that the majority of the cases at our institution that were being done using robotic technology also were using press fit technology. Our study’s results are similar to the results of the only other study comparing cementless vs cemented Ra-TKA, which was a single surgeon series [ 23 ]. Our series included 19 surgeons between 2 hospitals within a single healthcare system and had a larger patient population.…”

“…Our hypothesis was that our study would have results similar to those of McCormick et al. [ 23 ], showing no significant differences in short-term outcomes.…”

“…Cementless TKA has been of interest due to the theoretic ability to achieve bony ingrowth and a more durable biologic fixation [ 23 , 30 ]. The 1980s and 1990s saw the emergence of cementless TKA implants which had early failures with ingrowth, and were susceptible to osteolysis, [ 23 , 26 , 30 ] particularly at the tibial implant [ 30 ]. TKA patients are getting younger, more obese, and more active, [ 7 , 30 ] which increases our need for durable, long- term fixation.…”

“…To date, only one study has compared cementless Ra-TKA to cemented Ra-TKA [ 23 ] and they found no differences in survivorship or complication. This study was a single-surgeon series comparing 72 cemented cases to 380 cementless Ra-TKA.…”