JOA - 2026-04-02 - Journal Article
What Guides the Expert Knee Surgeon? Fixation and Patellar Resurfacing Decisions in Primary Total Knee Arthroplasty Among Knee Society Members.
Ganz MP, Tamer P, Scuderi GR
Topics
Key Takeaway
Among 104 Knee Society members, cemented fixation dominates at 72.9% average use, while patellar resurfacing rates vary from 0–100% with no consensus, and 40% of surgeons changed their resurfacing indications within the past 5 years.
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Summary
This survey of Knee Society members characterized practice patterns for fixation and patellar resurfacing in primary TKA. Of 104 respondents, 72.9% of cases used cemented fixation; 67.3% of surgeons used both cemented and cementless constructs, selecting cementless primarily based on age (70.0%) and bone quality (82.9%). Patellar resurfacing rates ranged from 0–100% across respondents, with degree of arthritis (53.7%) and patellar tracking (23.1%) as the leading decision drivers.
Key Limitation
Respondents are Knee Society members—a highly selected, high-volume subspecialty group—making these patterns non-representative of community or general orthopaedic surgeons who perform the majority of TKAs nationally.
Original Abstract
INTRODUCTION
Total knee arthroplasty (TKA) remains a highly successful and frequently performed procedure with variability in surgeon preferences regarding implant fixation and patellar resurfacing. This study aimed to characterize current practice patterns among members of The Knee Society and to identify key factors influencing implant fixation and patella resurfacing.
METHODS
A 23-question survey was distributed to 216 members of The Knee Society. The survey assessed demographic information, primary TKA volume, fixation technique preferences, patellar resurfacing practices, and the clinical rationale for these decisions. Responses were collected over a 4-week period in May 2025. Descriptive statistics were used to summarize the data.
RESULTS
The response rate was 48.1% (104 surgeons), with 52 (50.0%) being in practice greater than 25 years and 39 (37.9%) performing 201 to 300 primary TKAs annually. Cemented fixation was dominant, with an average use rate of 72.9%; 67.3% (70 surgeons) used both cemented and cementless implants, with an average cementless use of 35.8% of cases. Age (70.0%) and bone quality (82.9%) were the most cited indications for cementless use. Conversely, 35.6% (37 surgeons) reported using cemented fixation in all patients. Patellar resurfacing practices varied widely, with 34.7% (33 surgeons) reporting always resurfacing and individual rates ranging from 0 to 100%. 40.2% (41 surgeons) of respondents said their indications have changed in the past 5 years; resurfacing was most influenced by degree of arthritis (53.7%), patellar tracking (23.1%), and size/thickness (21.0 to 31.6%). Among surgeons performing cementless TKA, patellar resurfacing remained heterogeneous, and 40% (24 surgeons) still preferred cemented patellar components.
CONCLUSION
Cemented fixation in primary TKA remains the standard among expert TKA surgeons, though cementless techniques are increasingly used in select patients. Patellar resurfacing practices remain highly variable, reflecting individualized decision-making. These findings highlight evolving trends and underscore the need for continued research and consensus in primary TKA.