Similar survival between uncemented and cemented fixation prostheses in total knee arthroplasty: a meta-analysis and systematic comparative analysis using registers

Abstract

Purpose: The purpose of this analysis was to determine whether uncemented total knee arthroplasty performs as well as cemented total knee arthroplasty.

Methods: We searched PubMed, MEDLINE, and EMBASE, and major orthopaedic journals. This search was performed for the years from 1980 to the present. Randomised controlled trials and observational studies comparing cemented and uncemented fixation were identified. Effective data were pooled for meta-analysis. A systematic search was carried out using the EFORT website to identify the relevant arthroplasty registers.

Results: Nine studies were included in the meta-analysis. The combined odds ratio for failure of the implant due to aseptic loosening for the uncemented group over 5 and 10 years were 3.41 (p = 0.0001) and 4.73 (p = 0.0002), respectively. Subgroup analysis of data when design-related failed total knee arthroplasty (TKA)s were excluded showed no difference between the groups for odds of aseptic loosening (n.s.). There was no difference between the groups with respect to infection (n.s.). Pooled outcome of register data revealed that uncemented knees had a higher revision rate than cemented knees.

Conclusions: The important finding from the current study is that there is no evidence to support that fixation techniques alone affect the durability of a total knee arthroplasty when design-related failure in TKAs was excluded. The way of fixation is not relevant to the incidence of infection.

Level of evidence: IV.