Risk of Early Manipulation in Cemented Versus Cementless Total Knee Arthroplasty: An Analysis of the American Joint...

Cementless total knee arthroplasty (TKA) has recently regained popularity, yet data has raised concerns about rates of arthrofibrosis following these procedures. The purpose of this study was to utilize the American Joint Replacement Registry to compare rates of early manipulation under anesthesia (MUA) in cementless and cemented primary TKAs that use technology or manual instrumentation.

We queried the American Joint Replacement Registry for all patients ages 18 to 95 years who underwent cemented or cementless primary TKA over a 7-year period. Patients were stratified based on whether technology (robotics or computer-assisted navigation) was used during the primary surgery. Groups were then compared for rates of MUA within 90-day of the index surgery using multivariable logistic regression models. A total of 340,841 cases were included in the study, 78,397 (23%) of which used technology and 262,444 (77%) which did not. Within the technology cohort, there were 51,500 (65%) robotic and 26,897 (35%) navigated cases. There were 65% of technology-assisted TKAs and 92% of manual TKAs cemented.

In the technology group, multivariable analysis demonstrated significantly higher odds of MUA in cemented TKAs compared to cementless (odds ratio [OR] 1.95, 95% confidence interval [CI] [1.06 to 3.59]; P = 0.031). Robotic cases had significantly higher odds of MUA with cemented compared to cementless implants (OR 2.38, 95% CI [1.27 to 4.46]; P = 0.007), while there was no difference in MUA related to cementation in the navigated cases (OR 3.53, 95% CI [0.48 to 25.95]; P = 0.22). In the manual group, there were no significant differences in MUA rates related to cementation use (OR 1.14, 95% CI [0.8 to 1.64]; P = 0.46).

Cementless TKA did not increase odds of MUA. In further analyzing cement use into technology and manual cohorts, robotic-assisted cemented TKAs had higher rates of early MUA than cementless. Identification of risk factors leading to early arthrofibrosis may be patient dependent and further study is required to elucidate any surgical considerations.