title: Simultaneous cemented and cementless total knee replacement in the same patients: a prospective comparison of long-term outcomes using an identical design of NexGen prosthesis. Prospective results of uncemented tantalum monoblock tibia in total knee arthroplasty: minimum 5-year follow-up in patients younger than 55 years. A randomised controlled trial of cemented versus cementless press-fit condylar total knee replacement: 15-year survival analysis. A randomised, controlled trial of cemented versus cementless press-fit condylar total knee replacement. Ten-year survival analysis. Navigated Cementless Total Knee Arthroplasty - Medium-Term Clinical and Radiological Results§ Hydroxyapatite-coated, cementless total knee replacement in patients aged 75 years and over. Five- to 12-year follow-up of a hydroxyapatite-coated, cementless total knee replacement in young, active patients. Cement or Cementless Fixation in Total Knee Arthroplasty? Tibial fixation without screws in cementless total knee arthroplasty. Femoral component migration in total knee arthroplasty: randomized study comparing cemented and uncemented fixation of the Miller-Galante I design. Survival analysis of a cementless, cruciate-retaining total knee arthroplasty. Clinical and radiographic assessment 10 to 13 years after surgery. Proximally cemented versus uncemented Freeman-Samuelson knee arthroplasty. A prospective randomised study. Increased varus-valgus tilting of screw-fixated knee prostheses. Stereoradiographic study of uncemented versus cemented tibial components. Results of cementless total knee arthroplasty in an older rheumatoid arthritis population. Fixation of the NexGen HA-TCP-coated cementless, screwless total knee arthroplasty: comparison with conventional cementless total knee arthroplasty of the same type. Comparison of screw and screwless fixation in cementless total knee arthroplasty. Cementless LCS rotating-platform knee arthroplasty in patients over 60 years without patella replacement: a mid-term clinical-outcome study. Cement Versus Cementless Fixation In Total Knee Arthroplasty Excellent fixation achieved with cementless posteriorly stabilized total knee arthroplasty.
abstract: The purpose of this prospect i ve , r and omised study was to evaluate the clinical and radiological results comparing the identical cemented or cementless NexGen total knee prostheses implanted bilaterally in the same patient . Sequential simultaneous bilateral total knee replacements  were performed in 50 patients ( 100 knees ) . There were 39 women and 11 men with a mean age of 58.4 years ( 51 to 67 ) who received a cemented prosthesis in one knee and a cementless prosthesis in the other .  The mean follow-up was 13.6 years ( 13 to 14 ) . At final review , the mean Knee Society scores ( 96.2 ( 82 to 100 ) versus 97.7 ( 90 to 100 ) ) , the mean Western Ontario and McMaster Universities osteoarthritis index ( 34.5 ( 4 to 59 ) versus 35.6 ( 5 to 51 ) ) , the mean ranges of knee movement ( 124 ° ( 100 ° to 140 ° ) versus 128 ° ( 110 ° to 140 ° ) ) , mean patient satisfaction ( 8.1 ( SD 1.9 ) versus 8.3 ( SD 1.7 ) ) , and radiological results were similar in both groups . The rate of survival of the femoral components was 100 % in both groups at 14 years . The rate of survival of the cemented tibial component was 100 % and 98 % in the cementless tibial component .  No osteolysis was identified in either group . Our data have shown no advantage of cementless over cemented components in total knee replacement A significant increase in younger patients undergoing total knee arthroplasty raises the theoretical concern for revision secondary to micromotion and fixation failure with cemented components . We prospect ively studied 100 consecutive tantalum monoblock uncemented tibial components and 312 concurrent cemented controls . Patients younger than 55 years with adequate bone stock were enrolled . This cementless patient group was younger and had higher preoperative functional status . Prostheses were posterior-substituting uncemented femoral and tibial components with a cemented patellar button .  Knee Society pain and function scores and radiographs were obtained , and a cost analysis was performed . Knee Society scores were excellent and equivalent beyond 6 months . There was no significant difference in perioperative blood loss , complication rates , or cost . There was a significant decrease in operative time in the uncemented group . Radiographs revealed no failures of ingrowth at last follow-up . There were 3 uncemented group failures , but none were due to failure of fixation . The use of a porous tantalum tibia at minimum 5 years has yielded promising clinical and radiographic results in a younger patient population We report the long-term survival of a prospect i ve r and omised consecutive series of 501 primary knee replacements using the press-fit condylar posterior cruciate ligament-retaining prosthesis .  Patients received either cemented ( 219 patients , 277 implants ) or cementless ( 177 patients , 224 implants ) fixation . Altogether , 44 of 501 knees ( 8.8 % ) underwent revision surgery ( 24 cemented vs 20 cementless ) . For cemented knees the 15-year survival rate was 80.7 % ( 95 % confidence interval ( CI ) 71.5 to 87.4 ) and for cementless knees it was 75.3 % ( 95 % CI 63.5 to 84.3 ) . There was no significant difference between the two groups ( cemented vs cementless ; hazard ratio ( HR ) 0.83 , 95 % CI 0.45 to 1.52 , p = 0.55 ) . When comparing the covariates there was no significant difference in the rates of survival between the side of operation ( HR 0.58 , p = 0.07 ) , age ( HR 0.97 , p = 0.10 ) and diagnosis ( HR 1.25 p = 0.72 ) . However , there was a significant gender difference , with males having a higher failure rate with cemented fixation ( HR 2.48 , p = 0.004 ) . Females had a similar failure rate in both groups . This single-surgeon series , with no loss to follow-up , provides reliable data of the revision rates of one of the most commonly-used total knee replacements . The survival of the press-fit condylar total knee replacement remained good at 15 years , irrespective of the method of fixation We have carried out a long-term survival analysis of a prospect i ve , r and omised trial comparing cemented with cementless fixation of press-fit condylar primary total knee replacements . A consecutive series of 501 replacements received either cemented ( 219 patients , 277 implants ) or cementless ( 177 patients , 224 implants ) fixation .  The patients were contacted at a mean follow-up of 7.4 years ( 2.7 to 13.0 ) to establish the rate of survival of the implant . The ten-year survival was compared using life-table and Cox 's proportional hazard analysis . No patient was lost to follow-up . The survival at ten years was 95.3 % ( 95 % CI 90.3 to 97.8 ) and 95.6 % ( 95 % CI 89.5 to 98.2 ) in the cemented and cementless groups , respectively . The hazard ratio for failure in cemented compared with cementless prostheses was 0.97 ( 95 % CI 0.36 to 2.6 ) . A comparison of the clinical outcome at ten years in 80 knees showed no difference between the two groups . The survival of the press-fit condylar total knee replacement at ten years is good irrespective of the method of fixation and brings into question the use of more expensive cementless implants Purpose : The objective of this prospect i ve study was to evaluate the medium-term clinical and radiological results after navigated cementless implantation , without patella resurfacing , of a total knee endoprosthesis with tibial and femoral press-fit components , with a focus on survival rate and clinical outcome . The innovation is the non-cemented fixation together with the use of a navigation system . Scope and Methods : Sixty patients with gonarthrosis were included consecutively in this study . In all cases , the cementless Columbus total knee endoprosthesis with a coating out of pure titanium was implanted , using a navigation system . The Knee Society Score showed a statistically significant increase from 75 ( ± 21.26 ) before surgery to 180 ( ± 16.15 ) after a mean follow-up of 5.6 ( ± 0.25 ) years . The last radiological examination revealed no osteolysis . No radiolucent lines were seen at any time in the area of the femoral prosthetic components . In the tibial area , radiolucent lines were seen in 24.4 % of the cases , mostly in the distal uncoated part of the stem . During follow-up , no prosthesis had to be replaced because of aseptic loosening while in 2 cases revision surgery was necessary due to septic loosening and in 1 case due to unexplainable pain . Results and Conclusions : Navigated cementless implantation of the Columbus total knee endoprosthesis yielded good clinical and radiological results in the medium term . The excellent radiological osteointegration of the prosthetic components , coated with a microporous pure titanium layer and implanted with a press-fit technique , should be emphasized We have carried out a prospect i ve study comparing the results at five years in patients older than 75 years of age undergoing hydroxyapatite-coated , cementless total knee replacement ( TKR ) with those who were younger . The Knee Society clinical rating scores were recorded before and after operation . Of 559 patients undergoing TKR , 135 were in the elderly age group . The knee scores at five years or more showed comparable results , with patients under 75 years of age reaching a score of 183 and those aged 75 years or over reaching 174 . These differences were predominantly due to the functional component of the score . We conclude that elderly patients do just as well as the younger group using this prosthesis We carried out a prospect i ve study of 118 hydroxyapatite-coated , cementless total knee replacements in patients who were < /= 55 years of age and who had primary ( 92 ; 78 % ) or post-traumatic ( 26 ; 22 % ) osteoarthritis . The mean period of follow-up was 7.9 years ( 5 to 12.5 ) . The Knee Society clinical scores improved from a pre-operative mean of 98 ( 0 to 137 ) to a mean of 185 ( 135 to 200 ) at five years , and 173 ( 137 to 200 ) at ten years . There were two revisions of the tibial component because of aseptic loosening , and one case of polyethylene wear requiring further surgery . There was no osteolysis or progressive radiological loosening of any other component . At 12 years , the overall rate of implant survival was 97.5 % ( excluding exchange of spacer ) and 92.1 % ( including exchange of spacer ) . Cementless total knee replacement can achieve excellent long-term results in young , active patients with osteoarthritis . In contrast to total hip replacement , polyethylene wear , osteolysis and loosening of the prosthesis were not major problems for these patients , although it is possible that this observation could change with longer periods of follow-up A prospect ively studied group of 59 knees with cementless fixation were compared to a retrospectively studied but matched group of 59 knees with cement fixation using a Press Fit Condylar prosthesis .  The only significant preoperative difference between the patient groups was mean age ; the cemented group was on average nine years older than the cementless group ( p < 0.0001 ) . At an average of 2.8 years after surgery , there were no significant differences in knee scores between the two groups . Radiolucent lines adjacent to the tibial component were similar in both groups . The complication rate of 20 % in the cementless knees was higher than the 12 % rate in the cemented knees ; this was primarily related to polyethylene wear of metal-backed patellar components . Cement or cementless fixation of this prosthesis appears to provide equivalent early results This study examines the early clinical and radiographic results of the first 216 cases of a cementless fixed bearing tibial tray without screw holes in 191 patients . We hypothesize that stable fixation can be achieved without the use of screws . There were 16 cases lost to follow-up , leaving 200 cases with known outcome . The Hospital for Special Surgery knee scores improved from an average preoperative score of 54/100 to 82/100 postoperatively . Three patients had incomplete radiolucent lines involving the medial aspect of the tibial tray . All of the tibial components review ed radiographically were bone ingrown . We conclude that the tray provides excellent primary stability , allowing early bone ingrowth , free from osteolysis and with good clinical outcomes . All of the tibial components were bone ingrown by radiographic criteria The Miller-Galante I knee replacement was inserted in 25 women and three men ( 33 knees ) with osteoarthrosis . All patients received a TiAlV femoral component with a commercially pure titanium fiber-mesh undersurface . Cemented or cementless fixation was used based on a r and omization protocol . Micromotions of the femoral components were recorded with roentgen stereophotogrammetric analysis during the first 2 postoperative years . The magnitude of migration did not differ between cemented and uncemented fixation . The number of nonmigrating prostheses decreased from 21 ( 12 cemented and nine uncemented ) at 3 months to six ( three cemented and three uncemented ) at 24 months . In both groups , the magnitude of prosthetic tilting about the longitudinal axis ( internal-external rotation ) was as large as that about the transverse axis ( flexion-extension ) . Rotation into extension was as common as rotation into flexion . The largest translations were recorded at either of the posterior condyles . In 10 uncemented components , radiolucent lines were seen at the distal interface postoperatively . Proximal migration of the femoral component was recorded in these knees , and the width of the lines decreased or the lines disappeared totally at 24 months . After 2 years , lines were noted around four cemented and four uncemented replacements , mainly anteriorly or distally . All of these prostheses migrated . One prosthesis , revised because of malalignment , displayed pronounced migration after an initial period of stability . Bone ingrowth was observed anteriorly and anterodistally despite the presence of motions of 1 mm or more We performed a prospect i ve study of 54 patients ( 76 knees ) who underwent Osteonics series 3000 cruciate-retaining cementless total knee arthroplasty between December 1990 and June 1993 . Five patients ( seven knees ) were lost to follow-up ( 90.7 % completion ) . One patient required revision at 10.5 years after operation . The rate of survival was 100 % at ten years and 96.7 % at 13 years . The mean ten-year knee and function scores were 79 and 59 respectively . Both were significantly better than the pre-operative scores . The range of movement also improved . Although a radiolucent line around the tibial component enlarged in six knees ( 20.7 % ) at ten years , the clinical outcome was generally good . In a patient who died after 5.5 years , post-mortem examination of the knee showed no bony ingrowth into the tibial component . Despite poor bony ingrowth , press-fit fixation was satisfactory and good results can be obtained with this cementless , cruciate-retaining prosthesis We studied the effect of a layer of cement placed under the tibial component of Freeman-Samuelson total knee prostheses  with a metal back and an 80 mm intramedullary stem , using roentgen stereophotogrammetry to measure the migration of the tibial component during one year in 13 uncemented and 16 cemented knees . The addition of cement produced a significant reduction in migration at one year , from a mean of 1.5 mm to one of 0.5 mm ( p less than 0.01 ) , including a significant reduction in pure subsidence . One year postoperatively the clinical results were similar between the groups , but , at three years , one uncemented knee had required revision Twenty-six women and three men ( 34 knees ) with osteoarthrosis were operated with the Miller-Galante I ( Zimmer , Warsaw , IN ) knee prosthesis . The patients were r and omized to either cemented or uncemented fixation of the tibial component . All patients received a TiVaAl alloy tibial plate with four pegs and titanium fiber-mesh undersurface . In the uncemented knees four screws were added . The fixation of the tibial component was determined by roentgen stereophotogrammetric analysis during the first 2 postoperative years . Rotations of the entire tibial component were recorded , as well as proximal or distal translation of various parts of the prosthetic edge corresponding to subsidence and lift-off . The uncemented components displayed almost all rotation and translation during the first 6 weeks , whereas the cemented ones displayed a more gradually increasing migration during the 2 years . Tibial component rotation about the sagittal axis was significantly increased in the uncemented knees throughout the investigation period . This corresponded to increased subsidence medially or laterally in the uncemented knees , whereas lift-off was equal in the two groups . Thin ( 8.5 mm ) uncemented tibial components displayed more subsidence than the thicker ones at the medial or lateral edge 3 months after surgery Fifty-five total knee arthroplasties ( TKAs ) in thirty-nine adult ( mean age , 62 years ) patients with rheumatoid arthritis were studied prospect ively for a period of 1 - 7 years . All of the procedures were performed using cementless fixation of the tibial and femoral components . The Knee Society clinical rating system mean knee scores increased 56 points after operation ( mean , 88 points ) , and the mean functional scores increased 28 points ( mean , 64 points ) . Two revisions ( 4 % ) have been required , one for secondary late infection and one for failure of a cementless metal-backed patellar component . Good bone stock was retained in both , allowing for uneventful cementless revision . Forty-two arthroplasties ( 76 % ) were completely pain-free , twelve ( 22 % ) had mild , occasional discomfort with weight-bearing , and one ( 2 % ) had moderate pain at last examination . In this older rheumatoid population , cementless TKA offers good or excellent early clinical results and excellent preservation of bone stock should revision become necessary We performed a 12-month prospect i ve study on 59 patients ( 92 knees ) who underwent NexGen ( Zimmer Inc , Warsaw , IN ) cruciate-retaining total knee arthroplasty .  In the control group , uncoated components were fixed using screws , whereas the hydroxyapatite-tricalcium phosphate ( HA-TCP ) group underwent screwless fixation of coated components . At 12 months postoperatively , there was a radiographic clear zone around the femoral and tibial components of 56.5 % and 32.6 % of the knees in the control group . The HA-TCP group showed a clear zone at the medial aspect of the tibial component in only 1 knee . These results suggested that HA-TCP-coated articular components show good initial fixation without using screws . The NexGen coated knee arthroplasty may be useful for solving the problems of cementless fixation This study compared two groups of consecutive patients undergoing total knee arthroplasty ( TKA ) with an identical cementless tibial baseplate supplementally fixated with and without screws . In 58 TKAs , two 6.5-mm cancellous screws were used for fixation , and in 58 TKAs , screwless fixation was used . Clinical evaluation was performed using the Hospital for Special Surgery knee score , and fluoroscopically guided radiographs were evaluated for radiolucencies . In the screw fixation group , average follow-up was 82+/-6 months ( range , 59 - 89 months ) and average patient age at surgery was 63 years . For the screwless fixation group , average follow-up was 67+/-5 months ( range , 48 - 76 months ) and average patient age at surgery was 62 years .  Average knee score was 97 for the screw fixation group and 98 for the screwless fixation group . This study demonstrated stability in cementless TKA both with and without screw fixation in the mid-term using the Natural-Knee II tibial component BACKGROUND The aim of this prospect i ve paper is to present the results of a cementless LCS rotating-platform artificial knee design without resurfacing of the patella in patients over 60 years of age . MATERIAL / METHODS In this prospect i ve series , 234 patients were included with 251 knees . The LCS rotating-platform uncemented design was used in all cases , without replacement of the patella . Thirty-four patients were men and 200 were women . Two hundred three patients were suffering from osteoarthrosis ( 10 bilateral ) and 31 patients ( 7 bilateral ) from rheumatoid arthritis . Seventeen patients had a bilateral procedure . Prophylactic antibiotics and anticoagulants were also instituted to all patients . RESULTS Forty-nine patients developed deep vein thrombosis and responded well to the applied conservative treatment . Overall results in the first 251 cementless cases at 2 to 9.8 years ' follow-up ( average : 5.7 years ) were good to excellent in 94.4 % , fair in 4.7 % , and poor in 0.7 % . Radiographs of the knees showed good bonding and no signs of radiolucency . The average clinical and functional Knee Society Ratings were 21.07 points and 30.95 points , respectively , preoperatively and 87.95 points and 78.56 points , respectively , at the final follow-up evaluation . CONCLUSIONS With an average follow-up of 5.7 years , uncemented LCS rotating-platform knee joint arthroplasty without replacing the patella in patients over 60 years old was found to perform well , with encouraging clinical and radiological results and a survival rate of 98.1 % A prospect ively studied group of 55 uncemented Press Fit Condylar total knee arthroplasties was compared retrospectively with a matched group of 51 cemented Press Fit Condylar total knee arthroplasties  at a mean of 10 years after operation . For the cemented group , the pain and function scores improved from 32 and 45 preoperatively to 95 and 77 , respectively . For the uncemented group the scores improved from 33 and 50 preoperatively to 93 and 60 , respectively . There were 10 revisions in the uncemented group for femoral or tibial aseptic loosening or osteolysis compared with two revisions in the cemented group . Exclusive of problems related to patellar metal backing , survival to revision for aseptic failure or radiographic loosening was 72 % in the uncemented group and 94 % in the cemented group at 10 years . A significantly higher revision rate was found in the uncemented compared with cemented total knee arthroplasty of the Press Fit Condylar design Cementless posteriorly stabilized ( PS ) total knee arthroplasty has not been widely accepted primarily because of prior unpredictable results and concern about micromotion at the tibial fixation interface caused by the cam/post interaction . A prospect i ve consecutive series of 114 cementless , tricompartmental periapatite-coated single-radius PS implants in 110 patients with a mean age 62 years was performed to determine if initial stability and biologic fixation could be achieved . At a mean follow-up of 36 months , all implants demonstrated radiographic evidence of stable biologic fixation with no evidence of loosening , osteolysis , stress shielding , or progressive radiolucent lines . Based on these early results , cementless , periapatite-coated single-radius PS total knee arthroplasty offers marked promise
target: Implant survivorship for cementless TKA was comparable to the current gold st and ard cemented TKAs
background: Cementless  total knee arthroplasty ( TKA )  has had limited use in the United States , however , recent reports have demonstrated promising results , but there has been no meta- analysis to examine these outcomes in the past 5 years .