Cementless TKA use as an alternative to cemented TKA in high BMI patients: A systematic review and meta-analysis.

PURPOSE

Obesity is prevalent, with nearly one-third of the world's population being classified as obese. In patients with high body mass index (BMI)/body mass undergoing total knee arthroplasty (TKA), there is an increase in strain placed on the implant fixation interfaces. As such, component fixation is a potential concern when performing TKA in the obese patient. To address the growing concerns around the longevity of implant fixation, some have advocated cementless over cemented fixation. However, there is no clear consensus on whether a cementless fixation has more favourable outcomes. The aim of this paper was to present a systematic review and meta-analysis of the existing evidence to establish if cementless TKA has a lower rate of aseptic loosening in high BMI patients when compared to cemented TKA procedures.

METHODS

A systematic review was performed, and the following databases Medical Literature Analysis and Retrieval System Online (1946 to date), PubMed (1966 to date) and Excerpta Medica Database (1974 to date) were searched. All studies comparing cementless to cemented TKA in patients with BMI > 30 were considered. Meta-analysis compared aseptic loosening and all-cause revision between cemented and uncemented implant use in BMI > 30 patients.

RESULTS

The search returned 91 articles in total; after duplicates were removed, the yield was 44 studies. Of the remaining studies that were assessed, three studies met the inclusion criteria for meta-analysis. The pooled odds ratio for all-cause revisions was 0.17 (95%, 0.08-0.36) in favour of uncemented implants ( < 0.01). The pooled odds ratio for aseptic loosening was 0.15 (95% confidence interval, 0.02-0.90) in favour of uncemented implants ( = 0.04).

CONCLUSIONS

Meta-analysis demonstrated a significant decrease in all-cause revisions and revisions for aseptic loosening when using uncemented fixation in high BMI patients when compared to the use of cemented implants.

LEVEL OF EVIDENCE

The level of evidence is 1 for our systematic review.