2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Five Year Outcomes of Cemented Versus Cementless Total Knee Arthroplasty in a Cohort of 5,266 Patients

Ophélie Manchec, MD, Toulouse FRANCE
Etienne Cavaignac, MD,PhD, Toulouse FRANCE
Etienne Massardier, MD, Lyon FRANCE
Emilie Berard, MD, Toulouse FRANCE
Sebastien Lustig, MD, PhD, Prof., Lyon, Rhône Alpes FRANCE

CHU Purpan, TOULOUSE, FRANCE

FDA Status Cleared

Summary

Given the ongoing debate regarding the fixation techniques for Total Knee Arthroplasty (TKA), and with the increasing number of these procedures, we conducted a study on a large patient cohort to compare the survival rates of cemented versus cementless TKAs.

Abstract

Purpose

The number of Total Knee Arthroplasty (TKA) is increasing along with obese population and younger patient. The method of fixation is still subject to controversy. Our primary hypothesis is that there is no difference in survivorship between cemented and cementless TKA. Our secondaries hypothesis that there is no difference in revision for non septic cause and that there is no difference on functional and radiological outcome between cemented and cementless TKA at mid-term follow-up.

Methods

We performed a multicentric retrospective cohort study based on data collected prospectively in an industrial database. Patients were divided in 2 groups according to the method of fixation: cemented and cementless. We compared the survival rate between cemented and cementless TKA. Functional outcome (International Knee Score (IKS), flexion) and radiological data were collected preoperatively and at the last follow-up.

Results

In the 5266 primary TKA included, there was 4549 cementless TKA and 717 cemented TKA. At 5 years, there was no significant difference between the survivorship of the cementless (98,7%, [98,2 ; 99,1]) and the cemented TKA (97,6%, [94,1 ; 99,1]) (p-value = 0,468). There was no significant difference in the surgery-free survival at 5 years between cementless (95,8%, [94,9 ; 96,5]) and cemented TKA (95,5%, [92,1 ; 97,5]) (p_value = 0,508) as well as in revision for non septic cause: cementless (96,9%, [96,2 ; 97,5]) and cemented TKA (97,5, [95,5 ; 98,6] (p-value = 0,355). There was no significant difference in functional outcome at 5 years with an IKS measured at 182 (± 19 ) in the cementless group and 174 (±29) in the cemented group and a flexion measured at 118 (±11) in the cementless group and 113 (±13) in the cemented group.

Conclusion

There is no observed difference in survivorship between cemented and cementless TKA at 5 years in this cohort of 5266 patients. Additionally, rates of reoperation and aseptic revision are similar across both fixation methods. Clinical outcomes show no significant variance between the two. Therefore, we can say that cementless fixation is a safe option for primary TKA.