To Cement or Not? Ten-Year Results of a Prospective, Randomized Study Comparing Cemented versus Cementless Total Knee Arthroplasty.

BACKGROUND

The optimal mode of fixation for total knee arthroplasty (TKA) continues to be a subject of debate.

METHODS

There were 100 cases enrolled to compare cemented and cementless TKA using a modular trabecular metal tibia. This is a report on the 91 cases with follow-up information, including 67 cases with a minimum 10-year follow-up: 36 cases in the cemented cohort (A) and 31 cases in the cementless cohort (B). We previously reported the 2- and 5-year results for this prospective, randomized trial. Knee Society Scores and Oxford scores were collected preoperatively and postoperatively.

RESULTS

The mean Knee Society Scores (94.4, 89.1, P = 0.21) and Oxford scores (44.1, 43.9, P = 0.80) were similar in both groups. Group A had two revisions at 5-year follow-up, with three additional revisions for polyethylene wear, osteolysis, and loosening at 10-year follow-up. Group B had two revisions at 5-year follow-up, with two additional revisions for polyethylene wear and instability and instability due to laxity at 10-year follow-up. In total, two group A cases and one group B case were revised for implant fixation complications. Survivorship with any revision as an end point was equivalent between the two cohorts (91.5%, 95.9%, P = 0.60), as was survivorship using tibial tray revision as an end point (93.7%, 95.9%, P = 0.55). No cases demonstrated any progressive radiolucencies. Group A had 5 cases with osteolysis (80% tibial), and Group B had two cases of osteolysis (0% tibial).

CONCLUSIONS

Cementless and cemented TKA had equivalent patient-reported outcomes and survivorship at 10-year follow-up. Cemented fixation had a higher rate of osteolysis and loosening, which may be related to increased third-body wear. Cementless fixation shows immense potential as a successful option for many patients. Updates to this study cohort are planned at 15- and 20-year intervals to obtain longer-term outcomes.