Cementless Total Knee Arthroplasty Outcomes Are Comparable Across Age Groups: A National Database Study

Despite the growing use of cementless total knee arthroplasty (TKA), advanced age is often considered a relative contraindication, although there is limited data to support this. This study aimed to assess the impact of age, stratified into four groups (< 60, 60 to 70, 70 to 80, and > 80 years of age), on rates of periprosthetic fracture (PPFx), periprosthetic joint infection, aseptic loosening, and aseptic revision at 90 days, one year, and two years following cementless TKA.

A national all-payer database was utilized to identify patients who underwent TKA from 2010 to 2023 with cementless fixation. Patients who had a traumatic etiology or history of malignancy were excluded. Patients were placed into cohorts based on age: under 60, 60 to 70, 70 to 80, or over 80 years of age. A 1:1 match was employed based on the Charlson Comorbidity Index, sex, diabetes, obesity, alcohol abuse, and tobacco use, resulting in four cohorts of 1,134 patients each. We assessed the incidence of PPFx, periprosthetic joint infection, aseptic loosening, and aseptic revision at 90 days, one year, and two years. Odds ratios (ORs) were calculated using 95% confidence intervals (CIs).

At 90 days, one year, and two years, no significant differences were observed among cohorts for any complications (all P > 0.05). When compared to the < 60-year cohort, the > 80-year cohort did not demonstrate an increased risk of aseptic loosening (OR 0.46, 95% CI 0.17 to 1.21) or PPFx (OR 3.0, 95% CI 0.6 to 14.9) at two years.

Rates of all complications, including PPFx and aseptic loosening, were comparable across age groups ranging from < 60 to > 80 years. These findings suggest that cementless fixation is a viable option for patients undergoing TKA regardless of age.