Evolution of tibial fixation in total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomaterials Engineering
• Biomedical Engineering

Background:

• Cementless total knee arthroplasty (TKA) was developed to avoid cement-related issues like particle generation and degradation.
• The goal was to improve long-term fixation and suitability for younger patients undergoing TKA.
• However, cementless implants have presented unique complications, including radiolucent lines, aseptic loosening, and osteolysis.

Purpose of the Study:

• To evaluate the efficacy and complications of cementless total knee arthroplasty (TKA).
• To compare cementless TKA outcomes with traditional cemented prostheses.
• To assess the potential of newer porous metal devices in addressing cementless TKA challenges.

Main Methods:

• Review of clinical studies and critical analyses of cementless TKA outcomes.
• Comparison of complication rates and fixation methods between cemented and cementless TKA.
• Evaluation of early in vitro and in vivo data for novel porous metal cementless implants.

Main Results:

• Cementless TKA has shown significant issues with fixation, including radiolucent lines and aseptic loosening.
• Osteolysis and patellar component dissociation are notable complications associated with cementless designs.
• Cemented prostheses continue to demonstrate excellent long-term results in TKA.

Conclusions:

• Despite initial promise, cementless TKA faces challenges with implant fixation and associated complications.
• Cemented fixation remains the benchmark ('gold standard') for TKA due to its reliable outcomes.
• Porous metal cementless devices require further rigorous evaluation against established cemented techniques.