Cemented vs. cementless fixation in primary total knee arthroplasty: a systematic review and meta-analysis

Abstract

Over 100,000 total knee replacements (TKRs) are carried out in the UK annually, with cemented fixation accounting for approximately 95% of all primary TKRs. In Australia, 68.1% of all primary TKRs use cemented fixation, and only 10.9% use cementless fixation. However, there has been a renewed interest in cementless fixation as a result of improvements in implant design and manufacturing technology. This meta-analysis aimed to compare the outcomes of cemented and cementless fixation in primary TKR. Outcome measures included the revision rate and patient-reported functional scores. MEDLINE and EMBASE were searched from the earliest available date to November 2018 for randomized controlled trials of primary TKAs comparing cemented versus cementless fixation outcomes. Six studies met our inclusion criteria and were analysed. A total of 755 knees were included; 356 knees underwent cemented fixation, 399 underwent cementless fixation. They were followed up for an average of 8.4 years (range: 2.0 to 16.6). This study found no significant difference in revision rates and knee function in cemented versus cementless TKR at up to 16.6-year follow-up. Cite this article: EFORT Open Rev 2020;5:793-798. DOI: 10.1302/2058-5241.5.200030

Long-term effects of cemented and cementless fixations of total knee arthroplasty: a meta-analysis and systematic review of randomized controlled trials

“…A meta-analysis [ 8 ] including 7 randomized controlled trials (RCTs) and quasi-RCTs with an average follow-up time of 7.1 years (range 2 to 16.6 years) found that the survival rate and clinical efficacy of the prosthesis was similar to complete cementless and cemented fixation. Similar revision rates and knee function improvements were also observed between the two fixation types in a meta-analysis [ 9 ] including RCTs with an average follow-up time of 8.4 years (range 2.0 to 16.6 years). In young patients (≤ 65 years old), cementless TKA was more effective regarding radiological [ 10 ] and clinical outcomes [ 11 ] compared to cemented TKAs.…”

A matched comparison of the patient-reported outcome measures of cemented and cementless total knee replacements, based on the National Joint Registry of England, Wales, Northern Ireland, and Isle of Man and England’s National PROM collection programme

“…The OKS has 12 items relating to knee pain and function, each scoring from 0 to 4, presented as an overall score on an ordinal scale between 0 and 48 (13). The mean scores are given together with the proportion attaining excellent (≥ 41 points on the OKS), good (34-41), fair (27)(28)(29)(30)(31)(32)(33), and poor (< 27) results defined by Kalairajah et al (16). The minimal clinically important difference (MCID) for the OKS has not been definitively quantified: it is thought to be between 3 and 5 points (13).…”

Highlighting the advantages and benefits of cementless total knee arthroplasty (Review)

“…Extended surveillance was recommended based on some evidence, as potential aseptic loosening was revealed in the case of some cementless prosthesis. Because of biological fixation, high post-operation immediate pain, for some patients, was reported with cementless prosthesis (68). A study of 778 subjects under 55 years of age with a mean surveillance of 14 years, performed by Gioe et al revealed superior survivorship in the group with cemented TKA.…”