What is the best method for lasting fixation in TKA (total knee arthroplasty)? The jury is still out, says new work from Rush University Medical Center in Chicago. The research team of Omar A. Behery, M.D., M.P.H., Sean M. Kearns, B.S., Justin M. Rabinowitz, M.D., Brett R Levine, M.D., M.S. undertook a study to compare patient-reported outcomes and complications between patients with cemented and cementless tibial component fixation of the same design.
Cementless Knee Technology: Hold Off?
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The scientists, who just presented their work at the annual meeting of the American Academy of Orthopaedic Surgeons, utilized data on 70 cementless knees and cemented controls matched on age, body mass index, medical comorbidities, and implant design.
According to their presentation, the authors found a 30% total complication rate in the cementless fixation group and 7% in the cemented fixation group. They also found a significantly higher rate of aseptic tibial loosening in the cementless fixation group compared to the cemented group (10% cementless versus 0% cemented).
Dr. Levine told OTW, “Cementless knee technology has improved but currently still seems inferior to cemented techniques. We didn’t think there would be such a difference in the number of revisions for cementless knees as we found. In this series the cemented knees had no revisions; in the cementless knees there were seven revisions for loosening and three others for issues not related to cementless knees.”
“Cementless technology for TKA has come a long way but still has further to go to be widely accepted in all patient populations. Maybe we should consider holding back on using cementless knees until we have a better solution for the tibial component and what we need to do on the design to get these implants to more reliably ingrow.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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