Cement versus cementless fixation in total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Medical Device Engineering

Background:

• Total knee arthroplasty (TKA) is a common procedure for end-stage knee osteoarthritis.
• Cemented and uncemented fixation methods are widely used, each with distinct biomechanical properties and clinical outcomes.
• Press Fit Condylar (PFC) knee implants are a prevalent design, necessitating comparative analysis of fixation techniques.

Purpose of the Study:

• To compare the long-term outcomes of cemented versus uncemented Press Fit Condylar total knee arthroplasties.
• To evaluate revision rates, functional scores, and implant survival between the two fixation methods.
• To identify potential differences in aseptic loosening and osteolysis between cemented and uncemented PFC TKAs.

Main Methods:

• Retrospective comparison of prospectively collected data from 55 uncemented and 51 cemented PFC TKAs.
• Mean follow-up period of 10 years post-operation.
• Assessment of pain and function scores, revision rates, and implant survival due to aseptic failure or radiographic loosening.

Main Results:

• Both cemented and uncemented TKAs showed significant improvements in pain and function scores post-operatively.
• The uncemented group experienced a higher number of revisions (10 vs. 2) primarily for aseptic loosening or osteolysis.
• Implant survival to revision for aseptic failure or loosening at 10 years was 72% for uncemented and 94% for cemented implants.

Conclusions:

• Uncemented Press Fit Condylar total knee arthroplasty demonstrated a significantly higher revision rate compared to cemented fixation.
• Cemented PFC TKAs exhibited superior long-term survival rates and better functional outcomes at the 10-year follow-up.
• These findings suggest a potential disadvantage of uncemented fixation for the Press Fit Condylar knee design regarding aseptic loosening and osteolysis.