Does cementless knee replacement save time? Any difference in early complications or failure?
Cementless Knee Replacement 27 Minutes Faster!?
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A team from Hospital for Special Surgery (HSS) in New York decided to take a closer look at these questions and submitted the results of their study, soon to be submitted to a journal, at the 2022 American Academy of Orthopaedic Surgeons annual meeting in Chicago. It is titled, “A Comparison of Cementless vs. Cemented Total Knee Replacement: Minimal Difference in Early Outcomes.”
Geoffrey Westrich, M.D., an orthopedic surgeon specializing in knee and hip replacement and research director emeritus of Adult Reconstruction and Joint Replacement at HSS and study co-author told OTW, “Cementless total knee replacement implants are becoming more commonplace as surgeon realize the potential benefits for their patients.”
The researchers looked at 598 primary, unilateral total knee replacement of the same design from 2016-2018 (170 cementless knee replacements and 428 cemented knee replacements). One pattern they noticed was that cementless total knee replacement patients tended to be younger and male.
Here are some of the other interesting conclusions from the study:
- Cruciate retaining knees were the most commonly performed cementless knee replacements
- Cementless knee replacements required less operative time
- The average length of stay was no different between cementless and cemented knee replacement patients (57 vs. 60.5 hours)
- No difference in 90-day readmission between cementless and cemented knee replacements (1.8% versus 0.9%)
- And using a cementless total knee saved surgeons an average of 27 minutes of OR time.
“In our study,” said Dr. Westrich to OTW, “cementless total knee implants saved about 25% of operating time but didn’t have a higher risk of complications compared to traditional cemented knee implants. This bodes well for the future of cementless knee implants, as they have the potential for greater longevity, especially for younger patients.”
“In patients with good bone quality, cementless knees will undoubtedly become more commonplace and could eventually replace cemented knees.”
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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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