Cementless fixation in total knee arthroplasty: past, present, and future

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Biomedical Engineering

Background:

• Cementless fixation in total knee arthroplasty (TKA) faced challenges with early designs, including screw track osteolysis and component failures.
• Historical reluctance to adopt cementless TKA stemmed from these documented failures.
• Past failures in cementless TKA designs are now correctable with modern advancements.

Purpose of the Study:

• To review the historical context of cementless fixation in TKA.
• To evaluate current long-term outcomes of cementless TKA.
• To discuss the future potential and advancements in cementless TKA.

Main Methods:

• Review of historical data and literature on cementless TKA failures.
• Analysis of recent advancements in biomaterials, including highly porous metals and crosslinked polyethylene.
• Evaluation of long-term clinical results comparing cementless and cemented TKA designs.

Main Results:

• Early cementless TKA designs experienced failures such as screw track osteolysis and polyethylene issues.
• Renewed interest is driven by improved biomaterials (highly porous metals, highly crosslinked polyethylene) and osseointegration.
• Long-term studies show successful cementless TKA designs achieving results comparable to cemented counterparts.

Conclusions:

• Correctable failure mechanisms and advancements in materials are revitalizing cementless TKA.
• Cementless fixation offers potential advantages including time savings and long-term osseointegration.
• Current evidence suggests cementless TKA can achieve long-term outcomes rivaling cemented procedures.