No difference in implant survivorship and clinical outcomes between full-cementless and full-cemented fixation in primary total knee arthroplasty: A systematic review and meta-analysis

Abstract

Background: The debate over the use of cemented or cementless fixation in total knee arthroplasty (TKA) has never stopped since cementless fixation was introduced. We undertook a systematic review and meta-analysis to evaluate the optimal mode of fixation (full-cementless vs. full-cemented) in TKA.

Methods: PubMed, Embase, and the Cochrane Library databases up to July 2017 were searched to identify randomised controlled trials (RCTs) and quasi-RCTs comparing full-cementless TKA and full-cemented TKA. The primary outcome was implant survivorship. Secondary outcomes included radiological outcomes (maximum total point-motion [MTPM], radiolucent line, rotation degree) and clinical outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] score, Knee Society Score [KSS] score, postoperative range of movement, blood loss and complications).

Results: Seven studies were included in the systematic review and meta-analysis. The mean follow-up was 7.1 years (range from 2 to 16.6 years). There was no difference in implant survivorship (RR, 0.98; 95% CI, 0.95-1.01; p = 0.25; I² = 0%), MTPM (weighted mean difference [WMD], 0.13 mm; 95% CI, -0.69-0.95; p = 0.75; I² = 89.3%) and radiolucent line (RR, 1.36; 95% CI, 0.57-3.23; p = 0.48; I² = 54%) between the cementless and cemented methods. There was a mean 0.22° more rotation in the full-cementless fixation group (95% CI, 0.13-0.32; p < 0.01; I² = 28.5%). There were no significant differences relating to clinical outcomes (WOMAC score, KSS score, postoperative range of movement, blood loss and complications) between the two fixation groups.

Conclusions: Although more overall component rotation is found in full-cementless fixation, the implant survivorship and clinical efficacy are likely similar between full-cementless and full-cemented fixation. However, future RCTs with similar cementless prosthetic coating and longer-term follow-up are still needed to confirm our findings.

Keywords: Cement; Cementless; Fixation; Total knee arthroplasty (TKA).