Cementless vs Cemented Tibial Fixation in Primary Total Knee Arthroplasty

J Arthroplasty. 2017 May;32(5):1510-1515. doi: 10.1016/j.arth.2016.12.023. Epub 2016 Dec 22.


Background: The ideal fixation for modern tibial components in total knee arthroplasty (TKA) remains controversial with uncertainty on whether cementless implants can yield equivalent outcomes to cemented fixation in early follow-up.

Methods: A series of 70 consecutive cases with reverse hybrid cementless fixation were matched to 70 cemented cases from 2008 to 2015 based on implant design and patient demographics.

Results: Cementless TKA demonstrated greater aseptic loosening (7 vs 0, P = .013) and revision surgery (10 vs 0, P = .001) than cemented fixation within 5 years of follow-up, but with no clinically significant differences in outcome scores.

Conclusion: It remains unclear whether early aseptic loosening in cementless TKA can be reduced with enhanced adjunct fixation and what proportion of early failure justifies the potential lifelong fixation through biologic ingrowth of cementless tibial components.

Keywords: cementless tibia; porous tantalum; porous titanium and aseptic loosening; reverse hybrid; total knee arthroplasty.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Arthroplasty, Replacement, Knee / instrumentation*
  • Arthroplasty, Replacement, Knee / methods*
  • Bone Cements*
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Knee Prosthesis
  • Male
  • Middle Aged
  • Prosthesis Design / methods*
  • Prosthesis Failure*
  • Reoperation
  • Retrospective Studies
  • Tantalum / chemistry
  • Tibia / surgery*
  • Treatment Outcome


  • Bone Cements
  • Tantalum