A Systematic Review of Randomized Controlled Trials on Contemporary Cementless Total Knee Arthroplasty

The number of total knee arthroplasties (TKAs) continues to grow, and there is a renewed, growing interest in cementless fixation. The aim of this study was to perform a systematic review of recent randomized controlled trials (RCTs) evaluating contemporary cementless TKA survivorship and patient-reported outcome measures (PROMs).

A search of PubMed and Embase was performed. Inclusion criteria consisted of RCTs evaluating the survivorship and PROMs of contemporary cementless TKA published between January 1, 2010, and December 31, 2024. Manuscripts written in languages other than English, retrospective reviews, case-control studies, and prospective cohort studies were excluded. A total of 27 studies met final inclusion. Modified Coleman methodology scoring and level of evidence were determined for all studies. Large database and registry studies were excluded given the low modified Coleman methodology scores, lack of long-term outcomes and control groups, and relatively small proportions (less than 5%) of cementless TKAs compared to cemented TKAs.

The survivorship of contemporary cementless TKAs in the RCTs ranged from 93.7 to 100% at a mean follow-up of two to 17 years, and the survivorship of cemented TKAs ranged from 90 to 100% at the same mean follow-up. Of the 27 RCTs, 25 demonstrated at least equivalent survivorships for cementless versus cemented fixation. Of the 24 studies that evaluated PROMs, 20 studies demonstrated no substantial difference between groups, and four studies showed improved PROMs for cementless TKA.

Based on the highest quality evidence, contemporary cementless TKA demonstrates similar levels of survivorship and PROMs compared to cemented TKA at a mean follow-up of two to 17 years.