JOA - 2026-04-21 - Journal Article
Survivorship of Cemented Versus Cementless Total Knee Arthroplasty Using the Same Contemporary Design: A Minimum Five-Year Follow-Up Study.
Megaloikonomos PD, Sheridan GA, Neufeld ME, Howard LC, Greidanus NV, Garbuz DS, Masri BA
Topics
Key Takeaway
Cementless TKA achieved 99.5% 5-year all-cause revision survivorship versus 98.5% for cemented TKA using the same contemporary implant design, with no difference in aseptic loosening or radiolucent line prevalence.
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Summary
This study compared minimum 5-year survivorship of cemented versus cementless primary TKA using the same contemporary implant design at a single institution. All-cause revision rates were 1.5% cemented versus 0.5% cementless (P>0.05), with zero aseptic loosening in either group. Non-progressive radiolucent lines were present in 10.7% of cemented and 9.9% of cementless knees (P>0.05), with no component subsidence in either cohort.
Key Limitation
The absence of randomization and unreported fixation selection criteria introduce selection bias, making it impossible to exclude systematic differences in patient bone quality, activity level, or surgeon preference between groups.
Original Abstract
INTRODUCTION
Attention to biologic fixation has been growing in total knee arthroplasty (TKA) over the past years due to the evolution of highly porous metals and improved implant designs. The aim of this study was to assess the minimum five-year survivorship of a contemporary cementless TKA design, as compared to its cemented counterpart.
METHODS
We reviewed 261 cemented and 222 cementless primary TKAs that were performed at our institution between May 1, 2018 and May 31, 2019 using the same implant design. Demographic data, including age, sex, body mass index (BMI), and American Society of Anesthesiologists (ASA) score, were collected. We assessed survivorship and compared aseptic loosening, all-cause aseptic revision, and all-cause revision rate between groups. The presence of radiolucent lines was also evaluated on the most recent radiographs. Minimum follow-up was five years (mean, 5.8; range, 5.0 to 6.4).
RESULTS
A total of four revisions occurred in the cemented group: two for periprosthetic joint infection, one for patellar maltracking, and one for stiffness. The cementless group had one revision, which involved patellar resurfacing for patellar degeneration. No cases of aseptic loosening were recorded in either group. All-cause revision rate for aseptic reasons was 0.8% in the cemented and 0.5% in the cementless cohort, with no difference between them (P > 0.05). The 5-year all-cause revision survivorship was 98.5% in the cemented and 99.5% in the cementless group. Non-progressive radiolucent lines were observed in 28 (10.7%) cemented knees and in 22 (9.9%) cementless knees (P > 0.05). No radiographic evidence of component subsidence was identified in either group.
CONCLUSION
Cementless fixation TKA demonstrates excellent minimum five-year survivorship and radiographic outcomes, equivalent to those achieved with cemented fixation. Longer-term follow-up is warranted to further assess the durability of cementless implants and determine whether either fixation technique offers a long-term advantage.