Cementless Total Knee Arthroplasty Over the Past Decade: Excellent Survivorship in Contemporary Designs

Background: Cementless fixation in total knee arthroplasty (TKA) is re-emerging due to improvements in biomaterials, surgical technique, and implant design. Albeit rare, failure of osseointegration typically occurs within the first 2 years, and limited data exist on survivorship of the modern cementless TKA designs. This study evaluated clinical survivorship of 2 contemporary cementless TKA designs at minimum 2-year follow-up. Methods: A total of 627 cementless TKAs were performed up to July 2022. Three hundred thirty-nine cases were eligible for 2-year follow-up. Indications centered around bone quality and involved predominantly younger patients. The 2 designs consisted of tibial components with a highly porous titanium ingrowth surface, a central keel, and peripheral cruciform pegs with a porous cobalt-chromium femur. Survivorship estimates were calculated using right-censored non-parametric KaplaneMeier methodologies. A total of 226 TKAs obtained minimum 2-year follow-up with a mean of 3.6 years (range, 2 to 10). Results: The all-cause revision rate was 2.4% (8 of 339). The revision rate due to aseptic loosening was 0.6% (2 of 339) consisting of 2 femoral components. No tibial components were revised for aseptic loosening. KaplaneMeier survivorship free from aseptic loosening was 99% (95% confidence interval 98 to 100) at a maximum of 10 years. Conclusion: These results demonstrate encouraging survivorship of cementless fixation in primary TKA with use of contemporary ingrowth biomaterials and modern implant designs. This particular tibial implant design with a highly porous titanium fixation surface, central keel, and peripheral cruciform pegs demonstrated excellent clinical survivorship without failure which may portend superior fixation. Level of Evidence: IVecase series, no control group/historical control group. (c) 2023 Elsevier Inc. All rights reserved.

Automated summary

This study evaluates the clinical survivorship of two contemporary cementless total knee arthroplasty (TKA) designs with minimum 2-year follow-up. The results demonstrate encouraging survivorship of cementless fixation in primary TKA with the use of modern implant designs and biomaterials.