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

Abstract

Background To determine the long-term effects (a minimum follow-up time 8.8 years) of cemented and cementless fixations used for total knee arthroplasty (TKA). Methods PubMed, EMBASE, Ovid, Cochrane Library, CINAHL, China National Knowledge Infrastructure and China Wangfang database were interrogated for appropriate randomized controlled trials (RCTs) through July 2020. Data were extracted and assessed for accuracy by 2 of the authors acting independently. Any controversial discrepancies were resolved after discussion with a third author. Result Eight RCTs were included with low to moderate bias risks. The cemented fixation of TKA was comparable to cementless fixation in terms of implant survival (relative risk, 1.016; 95% CI 0.978 to 1.056; P = 0.417), Knee Society (KS) knee score (standardized mean difference (SMD), − 0.107; 95% CI − 0.259 to 0.045; P = 0.168), KS function score (SMD − 0.065; 95% CI − 0.238 to 0.109; P = 0.463), KS pain score (SMD − 0.300; 95% CI − 0.641 to 0.042; P = 0.085), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (SMD − 0.117; 95% CI − 0.307 to 0.073; P = 0.227), HSS score (SMD − 0.027; 95% CI − 0.270 to 0.217; P = 0.829), range of motion (SMD 0.061; 95% CI − 0.205 to 0.327; P = 0.652) at ≥ 8.8 years of follow-up. In terms of radiographic outcomes at ≥ 8.8 years of follow-up, the incidence of a radiolucent line in the cementless group was lower than for the cemented group (SMD 3.828; 95% CI 2.228 to 6.576; P < 0.001). However, the maximum total point motion (MTPM) of the cementless group was greater than for the cemented group (SMD − 0.739; 95% CI − 1.474 to − 0.005; P = 0.048). Conclusions Long-term follow-up verified that cementless and cemented fixation have similar prosthesis survival rates, clinical scores and mobility. However, radiography suggested that each technique had an advantage with regard to the radiolucent line and MTPM.

Sensor-guided gap balance versus manual gap balance in primary total knee arthroplasty: a meta-analysis

“…Continued advancements in technology and improvement in surgical techniques have made TKA surgery a very successful operation [ 25 ]. However, approximately one-third of early TKA revisions are related to unbalanced soft tissue presenting as stiffness, instability, or early component loosening [ 8 , 26 – 31 ].…”

Epidural Anesthesia versus General Anesthesia for Total Knee Arthroplasty: Influences on Perioperative Cognitive Function and Deep Vein Thrombosis

“…According to epidemiological data, there were as many as 600,000 cases of TKA in the United States in 2012, and the number is expected to increase to 1.26 million cases per year by 2030, imposing a huge burden on the healthcare system [ 4 ]. TKA has been shown to be beneficial to relieve patients' pain and improve long-term function and life quality [ 5 , 6 ]. However, this procedure is also accompanied by certain risk of complications, which may lead to postoperative cognitive dysfunction, deep vein thrombosis (DVT), and other adverse events [ 7 , 8 ].…”

The Knee-Fix study: study protocol for a randomised controlled trial evaluating cemented and cementless components in total knee arthroplasty

“…This prospective randomised controlled trial will help discern long-term differences between the two techniques. As uncemented implants can offer some clinical benefits [ 13 ], we plan to conduct non-inferiority analyses, that is, use of fully uncemented TKA is considered acceptable if it is not worse than the gold-standard fully cemented TKA.…”

“…The uncemented implants can also be cemented in situ, which provides the surgeon with intraoperative flexibility once bone quality is assessed. Early reports of the femoral and tibial components of this design show good survivorship in both registry data and peer-reviewed publications [6,[13][14][15]; however, some studies on previous designs of cementless patella components tend to have higher early revision rates, suggesting a lack of initial press-fit and bony ingrowth [16,17]. The higher coefficient of friction and rapid ingrowth seen with newer highly porous metal designs may alleviate this issue [11,18].…”