Giovanoulis Vasileios, Abboud Johnny, Vasiliadis Angelo V, Meissburger Victor, Koutserimpas Christos, Lustig Sebastien
Orthopaedics Surgery and Sports Medicine Department, Hôpital de la Croix-Rousse, Lyon, France.
Department of Orthopedic and Trauma Surgery, Hôpital André Mignot, Le Chesnay, France.
Arch Orthop Trauma Surg. 2025 Aug 28;145(1):429. doi: 10.1007/s00402-025-06035-z.
The optimal fixation technique for patellar components in primary total knee arthroplasty (TKA); cemented versus press-fit, remains controversial. While early press-fit designs were associated with complications, second-generation implants with improved osseointegration features have renewed interest in cementless fixation.
This systematic review included studies comparing cemented and press-fit patellar fixation in primary TKA. A comprehensive literature search identified 202 studies, of which eight met predefined inclusion criteria. Data were extracted on survivorship, revisions, complications, and patient-reported outcome measures (PROMs).
Across 1666 knees, survivorship was comparable between cemented and press-fit groups. Several studies reported 100% short-term survivorship in cementless cohorts. Four studies identified statistically significant PROM differences, but findings were inconsistent and context-dependent. No clear advantage was found for either fixation type in terms of overall pain, function, or satisfaction. Cementless patellae demonstrated no increased risk of aseptic loosening or patellar fracture. Complications were infrequent and more often reported in cemented groups.
These findings showed no significant difference in failure or PROMs between fixation methods. While surgical preference remains a driver of implant choice, current evidence does not support a universal superiority of one fixation method over the other.
在初次全膝关节置换术（TKA）中，髌骨假体的最佳固定技术（骨水泥固定与压配固定）仍存在争议。虽然早期的压配设计与并发症相关，但具有改善骨整合特性的第二代植入物重新引发了人们对非骨水泥固定的兴趣。
本系统评价纳入了比较初次TKA中骨水泥固定和压配固定髌骨的研究。全面的文献检索共识别出202项研究，其中8项符合预先设定的纳入标准。提取了关于生存率、翻修率、并发症以及患者报告结局指标（PROMs）的数据。
在1666个膝关节中，骨水泥固定组和压配固定组的生存率相当。多项研究报告非骨水泥队列的短期生存率为100%。四项研究确定了具有统计学意义的PROM差异，但结果不一致且取决于具体情况。在总体疼痛、功能或满意度方面，两种固定方式均未发现明显优势。非骨水泥髌骨未显示无菌性松动或髌骨骨折风险增加。并发症发生率较低，且在骨水泥固定组中报告得更多。
这些结果表明，两种固定方法在失败率或PROMs方面没有显著差异。虽然手术偏好仍然是植入物选择的一个驱动因素，但目前的证据并不支持一种固定方法普遍优于另一种。
