Review Article

Survivorship and complications of cementless compared to cemented posterior-stabilized total knee arthroplasties: A systematic review and meta-analysis

¹ Université Libre de Bruxelles, Av. Franklin Roosevelt 50, 1050 Brussels, Belgium
² Orthopaedic Department, EpiCURA Baudour, Hornu, Ath Hospitals, Rue Louis Caty 136, 7331 Saint-Ghislain, Hainaut, Belgium
³ 2nd Department of Orthopaedic Surgery and Traumatology, Aristotle University of Thessaloniki, “G. Gennimatas” General Hospital, Thessaloniki, Hellas, Greece
⁴ Laboratoire de Biochimie Osseuse et Métabolique ULB, Bone and Metabolic Biochemistry Research Laboratory, Université Libre de Bruxelles, Lenniksebaan 808, 1070 Brussels, Belgium

^* Corresponding author: jacques.hernigou@gmail.com

Received: 6 March 2024
Accepted: 23 April 2024

Abstract

Purpose: Controversy exists on the best fixation for total knee arthroplasty (TKA). Non-cemented fixation has been theorized to improve patient outcomes and longevity of implantation but no study has focused on comparison between cemented or cementless posterior-stabilized implants despite being the most commonly or second most frequently utilized implant in most total knee replacement registries. Methods: Inclusion criteria with observational and interventional papers, and review articles that focused on patients with cementless and cemented PS TKAs were used to analyze outcomes such as implant survivorship, complication, or revision rates. Using a combination of keywords, a systematic search was performed on Medline (PubMed), Embase, and Cochrane Library for Meta-Analysis. Results: When using the specified criteria, only 8 studies were selected for full-text analysis and meta-analysis after eliminating screening duplicates, titles, and abstracts without full-text access. These eight studies contain 1652 patients, 693 in the non-cemented Group, and 959 in the cemented total knee prosthesis Group. The meta-analysis revealed the advantage of cementless fixation over cemented fixation in implant survivorship, with 0.6% and 2.6% of aseptic loosening in each Group. The cumulative survival at 12 years was 97.4% for the cementless Group and 89.2% for the cemented Group. The subgroup with a stem showed a positive outcome for cementless fixation over cemented fixation regarding implant survivorship. No differences between the cemented and cementless TKAs were observed in patient-reported outcomes, revision rates, or radiolucent line development. Conclusion: We observed comparable rates for cemented and cementless posterior-stabilized TKAs over a medium-term follow-up period.