Comparable mid-term revision rates of primary cemented and cementless total knee arthroplasties in 201,211 cases in the Dutch Arthroplasty Register (2007-2017)

Knee Surg Sports Traumatol Arthrosc. 2021 Oct;29(10):3400-3408. doi: 10.1007/s00167-020-06183-2. Epub 2020 Aug 30.


Purpose: Long-term failure of total knee arthroplasty (TKA) is mostly due to loosening of the prosthesis. In this study, the short- and mid-term revision rates of cemented vs cementless TKAs were investigated. Comparable short- and mid-term survival rates of both fixation methods were expected.

Methods: Data on all cemented and cementless TKAs performed between 2007 and 2017 were retrieved from the Dutch Arthroplasty Register. The cumulative crude incidence of revision of cemented and cementless TKA was calculated. Death was considered a competing risk. Revision rates were compared using multivariable Cox proportional hazard regression analysis. The associations between fixation method and type of revision or reason for revision were tested using logistic regression analyses.

Results: In total, 190,651 (94.8%) cemented and 10,560 (5.3%) cementless TKAs were evaluated. Both groups had comparable case characteristics. Cemented TKAs were inserted more often in cases with previous knee surgery compared to cementless TKAs (32% vs 27%). The cumulative incidence of revision after 9 years was 5.5% (CI 5.3-5.6%) for cemented and 5.8% (CI 5.2-6.4%) for cementless TKAs (p = 0.2). Cementless TKAs were more often revised due to loosening of the tibial (27% vs 18%; p < 0.001) or the femoral component (7% vs 5%; p = 0.005) than cemented TKAs. Cemented TKAs were more often revised due to infection (17% vs 9%; p = 0.004) than cementless TKAs.

Conclusion: In conclusion, cemented and cementless TKAs have comparable short- and mid-term revision rates based on a nationwide register study.

Level of evidence: III.

Keywords: Cementation; Revision surgery; Survival; Total knee arthroplasty (TKA); Total knee replacement.

MeSH terms

  • Arthroplasty, Replacement, Knee*
  • Bone Cements
  • Humans
  • Incidence
  • Knee Prosthesis*
  • Prosthesis Design
  • Prosthesis Failure
  • Reoperation
  • Tibia
  • Treatment Outcome


  • Bone Cements