JOA - 2026-06-01 - Journal Article; Comparative Study
Cementless Total Knee Arthroplasty Outcomes Are Comparable Across Age Groups: A National Database Study.
Misch M, Katanbaf R, Swartz G, Mont MA, Nace J, Delanois RE
Topics
Key Takeaway
Cementless TKA complication rates—including PPFx (OR 3.0, 95% CI 0.6–14.9) and aseptic loosening (OR 0.46, 95% CI 0.17–1.21)—showed no statistically significant differences across age groups from <60 to >80 years at 2-year follow-up.
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Summary
This study asked whether advanced age increases complication risk after cementless TKA using a national all-payer database (2010–2023) with 1:1 propensity matching on CCI, sex, and key comorbidities across four age cohorts (<60, 60–70, 70–80, >80). No significant differences in PPFx, PJI, aseptic loosening, or aseptic revision were detected at any timepoint (all P>0.05). The >80-year cohort did not demonstrate significantly elevated risk for aseptic loosening (OR 0.46) or PPFx (OR 3.0) versus the <60-year cohort, though the PPFx confidence interval was wide.
Key Limitation
Maximum 2-year follow-up is inadequate to detect late aseptic loosening, which typically manifests at 5–10 years and represents the primary long-term concern with cementless fixation in osteoporotic bone.
Original Abstract
BACKGROUND
Despite the growing use of cementless total knee arthroplasty (TKA), advanced age is often considered a relative contraindication, although there is limited data to support this. This study aimed to assess the impact of age, stratified into four groups (< 60, 60 to 70, 70 to 80, and > 80 years of age), on rates of periprosthetic fracture (PPFx), periprosthetic joint infection, aseptic loosening, and aseptic revision at 90 days, one year, and two years following cementless TKA.
METHODS
A national all-payer database was utilized to identify patients who underwent TKA from 2010 to 2023 with cementless fixation. Patients who had a traumatic etiology or history of malignancy were excluded. Patients were placed into cohorts based on age: under 60, 60 to 70, 70 to 80, or over 80 years of age. A 1:1 match was employed based on the Charlson Comorbidity Index, sex, diabetes, obesity, alcohol abuse, and tobacco use, resulting in four cohorts of 1,134 patients each. We assessed the incidence of PPFx, periprosthetic joint infection, aseptic loosening, and aseptic revision at 90 days, one year, and two years. Odds ratios (ORs) were calculated using 95% confidence intervals (CIs).
RESULTS
At 90 days, one year, and two years, no significant differences were observed among cohorts for any complications (all P > 0.05). When compared to the < 60-year cohort, the > 80-year cohort did not demonstrate an increased risk of aseptic loosening (OR 0.46, 95% CI 0.17 to 1.21) or PPFx (OR 3.0, 95% CI 0.6 to 14.9) at two years.
CONCLUSIONS
Rates of all complications, including PPFx and aseptic loosening, were comparable across age groups ranging from < 60 to > 80 years. These findings suggest that cementless fixation is a viable option for patients undergoing TKA regardless of age.