Thirty-year outcomes of cemented versus cementless posterior-stabilized total knee arthroplasty

There are no long-term results (> 30 years) of cemented and cementless total knee arthroplasty (TKA) with respect to clinical outcomes, radiographic and computer tomographic (CT) findings, incidence of osteolysis, revision rates, and implant survivorship.

A consecutive cohort of 210 patients (mean age, 62 ± 4.6 years) underwent simultaneous bilateral TKA during a single anaesthetic session using the same posterior-stabilized prosthetic design. In each patient, one knee received a cemented implant and the contralateral knee received a cementless implant. The mean duration of follow-up was 30.3 years (range, 29-31 years).

At the final evaluation, no statically significant differences were observed between the two groups. The mean Knee Society scores (92 vs 93 points), Western Ontario and McMaster Universities Osteoarthritis Index scores (21 vs 10 points), range of motion (125° vs 127°) were not significantly different between the two groups. Revision was required in 3.8% of cemented knees and 4.8% of cementless knees. Kaplan-Meier analysis demonstrated a 30.3-year survival rate of 96.2% (95% confidence interval ([CI], 90%-100%) in the cemented group and 95.2% (95% [CI], 90%-100%) in the cementless group.

Both cemented or cementless fixation methods demonstrated durable and favourable long-term outcomes at more than 30 years. However, cementless TKA did not show superior survivorship compared with cemented TKA. At present, the routine preference of cementless fixation over established cemented techniques remains unsupported by long-term evidence.