Cemented Versus Cementless Primary Total Knee Arthroplasty in Obese Patients: A Systematic Review

Total knee arthroplasty (TKA) in obese patients (body mass index [BMI] > 30) is associated with increased complications. There is a renewed interest in cementless fixation in obese patients. However, the ideal method of TKA fixation in obese patients remains unclear. The literature was systematically reviewed to evaluate survivorship and functional outcomes of cemented versus cementless TKAs performed in obese patients. Complications, revision rates, and patient-reported functional outcomes were examined in studies comparing cemented and cementless fixation methods. Five articles met inclusion criteria to be included in the review. The cementless cohort had lower revision rates in two included studies but no difference in the three other studies examined. Functional outcomes were inconsistently reported. Overlap of patient cohorts and heterogeneity in reporting of functional outcomes precluded a pooled metaanalysis. Cementless TKA may have lower revision rates and better functional outcomes in obese patients, but paucity of data and inconsistency in reporting of functional outcomes prevents definitive conclusions. (Journal of Surgical Orthopaedic Advances 33(3):189-195, 2024).