Who Fails? Identifying Risks for Aseptic Loosening After Cementless Total Knee Arthroplasty.

Area of Science:

• Orthopedics
• Biomedical Engineering
• Epidemiology

Background:

• Cementless total knee arthroplasty (TKA) is increasingly utilized in younger, active individuals.
• Aseptic loosening remains a primary cause of failure in cementless TKA.
• Limited large-scale data exists on patient- and surgery-specific risk factors for aseptic loosening.

Purpose of the Study:

• To identify independent predictors of aseptic loosening in cementless TKA.
• To analyze demographic, clinical, and intraoperative variables associated with aseptic loosening.
• To inform preoperative risk stratification and personalized patient care.

Main Methods:

• Retrospective analysis of a national insurance claims database (2010-2022).
• Inclusion of adult patients undergoing uncemented TKA with at least two years of follow-up.
• Multivariable logistic regression analysis of 26,651 cases to identify independent risk factors.

Main Results:

• Younger age, higher comorbidity index, osteoporosis, rheumatoid arthritis, depression, anemia, corticosteroid use, and preoperative arthroscopy were associated with increased risk.
• Computer navigation assistance and bisphosphonate use demonstrated a protective effect against aseptic loosening.
• Aseptic loosening occurred in 4.0% (1,063 patients) within two years.

Conclusions:

• Patient comorbidities (osteoporosis, anemia, rheumatoid arthritis) and perioperative factors (prior arthroscopy) significantly influence aseptic loosening risk.
• Bisphosphonate use and computer navigation may offer protection against aseptic loosening.
• Findings underscore the need for preoperative risk assessment and tailored treatment strategies in cementless TKA.