A matched cohort study between cementless TKA and cemented TKA shows a reduction in tourniquet time and manipulation...

Cementless total knee arthroplasty (TKA) is now becoming more acceptable with the advent of newer ongrowth constructs and better initial fixation. It has been proposed that cementless TKA may save OR time and result in a lower incidence of manipulation. This study was designed to assess the difference between cemented and cementless TKA.

Our hospital statistician performed a matched cohort analysis between 127 cementless TKAs and 127 cemented TKRs performed by a single surgeon. Patients were matched on age and BMI. Mean tourniquet time between the cemented and cementless TKAs was assessed as well as the rate of manipulation between these groups. Of note, a tourniquet was routinely used in both the cementless and cemented cohorts to reduce confounding bias.

A total of 127 cementless TKAs with a mean age of 60.8 years and mean BMI 32.2 were compared to 127 cemented TKAs with a mean age of 61.5 years and mean BMI of 32.2 at an average follow-up of 2.0 years. There was a statistically significant reduction in tourniquet time in the cementless TKA cohort at 45.7 min compared to the cemented TKA cohort at 54.8 min (p = 0.001). Estimated blood loss was similar in both the cementless (179.5 ml) and cemented (196 ml) cohorts (p = 0.3) and postoperative outcomes, including UCLA score.In addition, the cementless TKA cohort had a manipulation rate of 0% compared to 3.1% for the cemented TKA group (p = 0.044).

While cementless and cemented TKA have shown similar PROMs and survivorship, we demonstrated a significant reduction in tourniquet time with cementless TKRs, with similar estimated blood loss, and a lower incidence of manipulation with cementless TKRs in this matched cohort study. The increased cost of a cementless implant may be negated if one considers the cost savings of not using cement, the cost savings of not performing manipulations, and the shorter operative time.