Cementless versus Cemented Total Knee Arthroplasty: A 5-Year Survivorship Analysis

The use of cementless fixation in total knee arthroplasty (TKA) has increased considerably in recent years. However, there remains a paucity of midterm survivorship data comparing cementless fixation to cemented fixation. The purpose of this study was to compare cementless and cemented TKA in terms of (1) the incidence of aseptic loosening and all-cause revision at one, two, and five years, and (2) 5-year implant survivorship.

A retrospective review was performed using a national all-payer claims database to identify patients who underwent primary TKA between 2015 and 2022. International Classification of Diseases-10th edition-procedure codes were used to determine the fixation method. We excluded patients who had less than five years of follow-up, trauma-related procedures, or malignancy. Propensity score matching was conducted based on age, sex, Charlson Comorbidity Index, and multiple comorbidities, yielding two cohorts: cementless (n = 5,526) and cemented (n = 5,538). Outcomes included the incidence of aseptic loosening and all-cause revision at one, two, and five years. Odds ratios with 95% confidence intervals were calculated. Kaplan-Meier analysis was used to assess 5-year survivorship.

At one year, the incidence of aseptic loosening was similar between cementless and cemented TKA groups (0.3 versus 0.3%, P = 0.730), as was all-cause revision (1.9 versus 1.7%, P = 0.151). At two years, aseptic loosening remained similar (0.6 versus 0.6%, P = 1.000), as did all-cause revision (2.7 versus 2.5%, P = 0.537). At 5 years, the incidence of aseptic loosening was 0.9 versus 1.2% (P = 0.165), and all-cause revision was 3.7 versus 3.8% (P = 0.781). In the cementless cohort, 5-year survivorship was 99.1% for aseptic loosening and 96.3% for all-cause revision.

Up to five years postoperatively, cementless TKA provides similar durability to cemented TKA for both aseptic loosening and all-cause revision.