Cemented vs. Cementless Fixation in Primary Knee Replacement: A Narrative Review

Area of Science:

• Orthopedics
• Biomaterials Science
• Gerontology

Background:

• Knee osteoarthritis (OA) is a primary cause of global disability, affecting both the elderly and younger individuals due to factors like sports overuse and obesity.
• Total joint replacement (TJR) is the standard treatment for end-stage knee OA, restoring function and reducing pain.
• Prosthesis fixation in TJR relies on either cemented (polymethyl-methacrylate) or cementless methods, each with implications for revision rates and long-term survival.

Purpose of the Study:

• To compare the efficacy and outcomes of cemented versus cementless fixation techniques in total knee replacement (TKR) surgery.
• To review the existing literature on TKR revision rates and survival times for different fixation methods.
• To inform clinical decision-making regarding the optimal fixation strategy for TKR.

Main Methods:

• A systematic literature search was conducted using PICO (Population, Intervention, Comparison, Outcomes) rules in PubMed.
• The search focused on articles published between 2010 and 2023, identifying 783 relevant studies.
• Fourteen studies were selected for inclusion in this review based on predefined criteria.

Main Results:

• The review found no universally superior method for knee prosthesis fixation.
• Both cemented and cementless TKR techniques have distinct advantages and disadvantages.
• The long-term revision rate and survival time are critical factors but lack established consensus.

Conclusions:

• The choice between cemented and cementless total knee replacement fixation should be individualized.
• Patient-specific factors and informed consent are paramount in selecting the most suitable fixation method.
• Further research may be needed to establish clearer guidelines for TKR fixation strategies.