From the Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH (Kamath, Siddiqi, Krebs), and the Department of Orthopedic Surgery, University of Louisville, Louisville, KY (Malkani).
J Am Acad Orthop Surg. 2021 Apr 15;29(8):e363-e379. doi: 10.5435/JAAOS-D-20-00569.
Cemented total knee arthroplasty (TKA) has been considered the benchmark, with excellent clinical outcomes and low rates of aseptic loosening at the long-term follow-up. However, alterations of the bone/cement interface leading to aseptic loosening, particularly in younger and obese patients, along with increased life expectancy have led to a renewed interest in noncemented TKA fixation. Certain early noncemented designs exhibited higher rates of subsidence and component failure. Improvements in designs, materials, and surgical technique offer promise for improved results with contemporary noncemented TKA applications. In an increasing cost-conscious healthcare environment, implant cost is important to consider because press-fit prostheses are generally more expensive. However, this cost may be offset by shorter surgical times, cement costs, and the potential for osseous integration. Technological advances have improved the manufacturing of porous metals, with reported excellent midterm survivorship. Future prospective, randomized trials, and registry data are needed to delineate differences between cemented and noncemented fixation, survivorship, and patient-reported outcomes, especially in young, functionally active, and/or obese populations.
骨水泥固定全膝关节置换术（TKA）一直被认为是金标准，具有出色的临床结果和低的无菌性松动率，长期随访结果良好。然而，骨/水泥界面的改变导致无菌性松动，尤其是在年轻和肥胖患者中，加上预期寿命的延长，促使人们对非骨水泥固定 TKA 重新产生兴趣。某些早期的非骨水泥设计表现出更高的下沉率和组件失效率。设计、材料和手术技术的改进为改善当代非骨水泥 TKA 应用的结果提供了希望。在日益注重成本的医疗保健环境中，植入物的成本很重要，因为压配合假体通常更昂贵。然而，这一成本可能会因手术时间更短、水泥成本以及骨整合的可能性而得到弥补。技术进步提高了多孔金属的制造工艺，中期随访结果显示其具有极好的存活率。未来需要前瞻性、随机临床试验和注册数据来阐明骨水泥固定和非骨水泥固定、存活率和患者报告结果之间的差异，尤其是在年轻、功能活跃和/或肥胖人群中。
