Comparison of Cemented and Uncemented Fixation in Total Knee Arthroplasty

Abstract

As a result of reading this article, physicians should be able to :1. Understand the rationale behind using uncemented fixation in total knee arthroplasty.2.Discuss the current literature comparing cemented and uncemented total knee arthroplasty3. Describe the value of radiostereographic analysis in assessing implant stability.4. Appreciate the limitations in the available literature advocating 1 mode of fixation in total knee arthroplasty. Total knee arthroplasty performed worldwide uses either cemented, cementless, or hybrid (cementless femur with a cemented tibia) fixation of the components. No recent literature review concerning the outcomes of cemented vs noncemented components has been performed. Noncemented components offer the potential advantage of a biologic interface between the bone and implants, which could demonstrate the greatest advantage in long-term durable fixation in the follow-up of young patients undergoing arthroplasty. Several advances have been made in the backing of the tibial components that have not been available long enough to yield long-term comparative follow-up studies. Short-term radiostereographic analysis studies have yielded differing results. Although long-term, high-quality studies are still needed, material advances in biologic fixation surfaces, such as trabecular metal and hydroxyapatite, may offer promising results for young and active patients undergoing total knee arthroplasty when compared with traditional cemented options.

Nanoscale surface modification by anodic oxidation increased bone ingrowth and reduced fibrous tissue in the porous coating of titanium–alloy femoral hip arthroplasty implants

“…Incremental improvements in acetabular and femoral component design, more open porous materials and newer porous metallic coatings using additive fabrication techniques have increased both the variety of coatings available and the expectation that more extensive and durable fixation will indeed be achieved . Cementless fixation of the tibial component in knee arthroplasty has also been successful, but remains less reliable than fixation using bone cement …”

Survivorship and Functional Outcomes of Cementless versus Cemented Total Knee Arthroplasty: A Meta-Analysis

“…12,13 To decrease the failures related to cemented implants, cementless TKA fixation was developed to potentially increase implant survivorship and preserve bone stock. 5,[14][15][16] The original cementless implants, however, were associated with aseptic loosening and osteolysis that resulted in high early failure rates. [17][18][19][20] Despite these early problems, innovations in biomaterials and implant design have led to improved osseointegration and implant fixation, which could potentially improve cementless TKA long-term survivorship.…”

“…[17][18][19][20] Despite these early problems, innovations in biomaterials and implant design have led to improved osseointegration and implant fixation, which could potentially improve cementless TKA long-term survivorship. 14,16,21,22 With newer implant designs, the optimal fixation for TKA components remains debatable, and therefore, the purpose of this meta-analysis was to assess the evidence supporting the use of cementless versus cemented TKAs. The specific aims were to evaluate (1) all-cause survivorship, (2)…”

Novel use of a trabecular metal spacer in the treatment of a long-standing ulnar fracture non-union

“…In spine surgery, TM implants without graft have shown satisfactory fusion rates and clinical outcomes in both cervical corpectomy and lumbar interbody fusion surgery 22. In knee surgery, TM implants have shown comparable results in total knee arthroplasty when compared with cemented implants, particularly in the young and active population 23. In ankle surgery, TM implants have been used successfully as a bone graft alternative in arthrodesis, with early reports also suggesting encouraging results from use in total ankle replacement 24…”