A randomised, controlled trial of cemented versus cementless press-fit condylar total knee replacement

Abstract

We have carried out a long-term survival analysis of a prospective, randomised trial comparing cemented with cementless fixation of press-fit condylar primary total knee replacements. A consecutive series of 501 replacements received either cemented (219 patients, 277 implants) or cementless (177 patients, 224 implants) fixation.The patients were contacted at a mean follow-up of 7.4 years (2.7 to 13.0) to establish the rate of survival of the implant. The ten-year survival was compared using life-table and Cox's proportional hazard analysis.No patient was lost to follow-up. The survival at ten years was 95.3% (95% CI 90.3 to 97.8) and 95.6% (95% CI 89.5 to 98.2) in the cemented and cementless groups, respectively. The hazard ratio for failure in cemented compared with cementless prostheses was 0.97 (95% CI 0.36 to 2.6). A comparison of the clinical outcome at ten years in 80 knees showed no difference between the two groups.The survival of the press-fit condylar total knee replacement at ten years is good irrespective of the method of fixation and brings into question the use of more expensive cementless implants. J Bone Joint Surg [Br] 2002;84-B:658-66. Received 27 July 2001; Accepted 24 September 2001 As the demand for knee replacement surgery increases resources need to be allocated to implants with the best long-term clinical outcome and survival rates.Liow and Murray 1 reported that 54% of knee prostheses, which were available in the UK did not have functional or survival results published in peer-reviewed journals. In their report, there were only five implants (13%) with published survival analyses of ten years or more and only five (13%) for which a functional outcome at more than five years was available. This paucity of data concerning the long-term outcome after total knee replacement (TKR) is alarming considering the rapid rise in the number of different designs of prostheses which are available. There is considerable debate regarding the possible benefits of using cementless fixation in joint replacement surgery. These include preservation of bone stock, ease of revision, the avoidance of complications of cementation and lastly, but most importantly, improved long-term survival of the implant. Although it is now clear that aseptic loosening is mainly related to wear debris rather than to cemented fixation, the question remains as to whether cementless implants have an improved long-term survival. This can only be answered by a randomised trial comparing the two methods of fixation. For TKR no such reports have been published in peer-reviewed journals. Our aim therefore was to compare the long-term survival, in a prospective randomised trial, of cemented with cementless fixation, using the press-fit condylar TKR system.

Total knee arthroplasty using cementless keels and cemented tibial trays: 10-year results

“…Cement versus cementless fixation for TKA continues to be a topic of debate and has received much attention in the literature [2,4,6,13]. However, little data exists concerning the issue of cement or cementless keel/stem fixation in association with cemented tibial tray fixation.…”

Cementless and cemented total knee arthroplasty in patients younger than fifty five years. Which is better?

“…Although it is now clear that aseptic loosening is mainly related to debris from polyethylene wear rather than failure of cemented fixation [12][13][14][15], the question remains whether cementless TKAs have an improved long-term survival. This can only be answered by a randomised trial comparing the two methods of fixation.…”

Trabecular Metal in Total Knee Arthroplasty Associated with Higher Knee Scores: A Randomized Controlled Trial

“…However, with time, problems with cementless implants have been overcome by better designs and new fixation systems, reducing the risk of early migration [62] and loosening of the tibial component [18], and resulting in clinical results and survivorship rates comparable to those achieved with cemented implants [5,7,8,18,19,24,25,33,40,46,51,65,66]. However, given the similarity of results, some of these authors have concluded that the lack of advantages of uncemented over cemented components would not support the use of more expensive implants [19,33].…”