A Comparison of Revision Rates for Cemented Versus Cementless Fixation for a
Single Prosthesis Posterior-Stabilized Total Knee Arthroplasty: Medium-Term
Follow-up of Cases from the UK National Joint Registry, and Radiographic Analysis
of a Northern Ireland Cohort
#MMPMID41210906
Hickland P
; Cassidy R
; Beverland D
; Diamond O
; Napier RJ
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41210906
show ga
BACKGROUND: Cementless total knee arthroplasty (TKA) offers several conceptual
benefits over cemented TKA. However, the effect of the cam-post interaction of
posterior-stabilized (PS)-TKA on implant osseointegration remains uncertain.
METHODS: Data were obtained from the UK National Joint Registry (UK NJR), on
patients who underwent primary PS-TKA for osteoarthritis using the Stryker
Triathlon system between January 1, 2010, and December 31, 2019. Patients were
excluded if they had an implausible body mass index (BMI) or where there was use
of bone graft, revision implants, or hybrid cementation. A local cohort of
patients were similarly identified, with additional postoperative radiographic
analysis performed. The primary outcome for both cohorts was all-cause
survivorship. RESULTS: There were 18,824 relevant PS-TKA: 1,068 (5.7%) cementless
and 17,756 (94.3%) cemented. The cementless group had a higher proportion of men
(48.7% vs. 41.9%), a lower median age (70 vs. 71 years), a higher median BMI (31
vs. 30 kg/m(2)), and shorter median duration of exposure to risk of revision (5.5
vs. 6.9 years, p < 0.01). All-cause revision rates were similar between the
cementless and cemented groups (2.4% vs. 2.8%, p = 0.49). The second cohort of
875 patients had no statistical difference in all-cause revision rates for
cementless and cemented PS-TKA (2.9% vs. 1.3%, p = 0.22), and radiographic
analysis of those with cementless implants revealed that revision was more likely
if there was radiographic loosening within the first 30 months postoperatively
(33.3% vs. 2.1% if absent). CONCLUSIONS: This study, the largest of its kind,
reports equivalent revision rates between cementless and cemented fixation of
PS-TKA in the medium term, suggesting that either fixation option was reasonable
for PS-TKA. This work complements existing NJR reports by providing a comparison
not readily available, for the PS design of what is currently the most used TKA
system in the United Kingdom. LEVEL OF EVIDENCE: Level III. See Instructions for
Authors for a complete description of levels of evidence.
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