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

Cementless fixation in total knee arthroplasty (TKA) has had limited use in recent decades due to past failures in the early generation of cementless designs. Screw track osteolysis, poor polyethylene, and metal-backed patellar component failures contributed to a controversial track record and created a reluctance to embrace cementless fixation in TKA; however, these failure mechanisms are correctable. In addition, there is renewed interest in cementless fixation due to the recent development of improved biomaterials, particularly highly porous metals and highly crosslinked polyethylene, as well as time-saving advantages and long-term osseointegration of cementless fixation. There are long-term reports of successful designs of cementless knee arthroplasty that are nearly equal to the results of cemented designs. This article discusses the past history, current long-term results, and future of cementless fixation in TKA.