Cementless tibial fixation in TKA: not a second coming

Cemented total knee arthroplasty (TKA), using mechanically sound components such as the total condylar system (Johnson & Johnson, New Brunswick, New Jersey), have been performed for >25 years. Long-term follow-up studies have shown excellent durability. In 1 series with a minimum 20-year follow-up, the revision rate for aseptic loosening was 3.5%. More contemporary prostheses, such as the low contact stress rotating platform (DePuy, Warsaw, Indiana) and Kinematic Knee systems (Howmedica, Rutherford, New Jersey), have demonstrated minimal loosening at 20-year follow-up. In a minimum 20-year follow-up of a rotating platform TKA, the revision rate for aseptic loosening was 0%. In a minimum 15-year follow-up of kinematic cruciate-retaining TKA, the revision rate for aseptic loosening was 1.8%. Cemented fixation is durable and forgiving. It can accommodate defects in bone as well as imperfect cuts that are not uncommon, even in the best of hands. It can interdigitate into soft and hard bone. With the development of modular tibial trays with better locking mechanisms and less abrasive surfaces, as well as the development of more wear-resistant polyethylene (gamma irradiated in an inert environment and crosslinked polyethylene), the osteolysis that developed around first generation modular components should be markedly less with newer designs. It is for these reasons that cement should remain the fixation of choice in TKA.