No difference in 5-year survivorship between cemented versus cementless total knee arthroplasty in a cohort of 5266 patients using a deep-dish mobile bearing implant

PurposeThe best fixation method for total knee arthroplasty (TKA) remains controversial. The aim of this study is to compare the effect of cemented and cementless fixation on prosthesis survivorship. Our primary hypothesis is that there is no difference in survivorship between cemented and cementless TKA. Our secondary hypothesis is that there is no difference in aseptic revisions and functional outcomes between cemented and cementless TKA at mid-term follow-up.MethodsA multicentre retrospective study was done using data collected prospectively in a large cohort. The same deep-dish mobile bearing design was used for both cemented and cementless TKA. Patients were divided into two groups according to the fixation method. The survival rate between cemented and cementless TKA was compared. Functional outcomes were collected preoperatively and at the 5-year follow-up.ResultsOf the 5266 primary TKA included, 4549 were cementless, and 717 were cemented. At 5 years, there was no significant difference between the survivorship of the cementless (98.7% [95% confidence interval, CI: 98.2-99.1]) and cemented TKA (97.6%, [95% CI: 94.1-99.1]) (p = 0.468). There was no significant difference in the surgery-free survival at 5 years between cementless (95.8% [95% CI: 94.9-96.5]) and cemented TKA (95.5% [95% CI: 92.1-97.5]) (p = 0.508) as well as in aseptic revision: cementless (96.9% [95% CI: 96.2-97.5]) and cemented TKA (97.5 [95% CI: 95.5-98.6]) (p = 0.355). There was no significant difference in the functional outcomes at 5 years.ConclusionThere was 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 were similar across both fixation methods, and clinical outcomes did not differ significantly. Therefore, it may be suggested that cementless fixation is a safe option for primary TKA.Level of EvidenceLevel III.