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. 2023 Apr;36(5):530-539.
doi: 10.1055/s-0041-1739201. Epub 2021 Nov 15.

Similar Healthcare Utilization and 1-Year Patient-Reported Outcomes between Cemented and Cementless Primary Total Knee Arthroplasty: A Propensity Score-Matched Analysis

Michael P Erossy  1 , Ahmed K Emara  1 , Christopher A Rothfusz  1 , Alison K Klika  1 , Michael R Bloomfield  1 , Carlos A Higuera  1 , Yuxuan Jin  2 , Viktor E Krebs  1 , Nathan W Mesko  1 , Robert M Molloy  1 , Trevor G Murray  1 , Preetesh D Patel  1 , Kim L Stearns  1 , Jonathan L Schaffer  1 , Gregory J Strnad  1 , Nicolas S Piuzzi  1
Affiliations

Similar Healthcare Utilization and 1-Year Patient-Reported Outcomes between Cemented and Cementless Primary Total Knee Arthroplasty: A Propensity Score-Matched Analysis

Michael P Erossy et al. J Knee Surg. 2023 Apr.

Abstract

Cementless fixation for total knee arthroplasty (TKA) has gained traction with the advent of newer fixation technologies. This study assessed (1) healthcare utilization (length of stay (LOS), nonhome discharge, 90-day readmission, and 1-year reoperation); (2) 1-year mortality; and (3) 1-year joint-specific and global health-related patient-reported outcome measures (PROMs) among patients who received cementless versus cemented TKA. Patients who underwent cementless and cemented TKA at a single institution (July 2015-August 2018) were prospectively enrolled. A total of 424 cementless and 5,274 cemented TKAs were included. The cementless cohort was propensity score-matched to a group cemented TKAs (1:3-cementless: n = 424; cemented: n = 1,272). Within the matched cohorts, 76.9% (n = 326) cementless and 75.9% (n = 966) cementless TKAs completed 1-year PROMs. Healthcare utilization measures, mortality and the median 1-year change in knee injury and osteoarthritis outcome score (KOOS)-pain, KOOS-physical function short form (PS), KOOS-knee related quality of life (KRQOL), Veteran Rand (VR)-12 mental composite (MCS), and physical composite (PCS) scores were compared. The minimal clinically important difference (MCID) for PROMs was calculated. Cementless TKA exhibited similar rates of median LOS (p = 0.109), nonhome discharge disposition (p = 0.056), all-cause 90-day readmission (p = 0.226), 1-year reoperation (p = 0.597), and 1-year mortality (p = 0.861) when compared with cemented TKA. There was no significant difference in the median 1-year improvement in KOOS-pain (p = 0.370), KOOS-PS (p = 0.417), KOOS-KRQOL (p = 0.101), VR-12-PCS (p = 0.269), and VR-12-MCS (p = 0.191) between the cementless and cemented TKA cohorts. Rates of attaining MCID were similar in both cohorts for assessed PROMs (p > 0.05, each) except KOOS-KRQOL (cementless: n = 313 (96.0%) vs. cemented: n = 895 [92.7%]; p = 0.036). Cementless TKA provides similar healthcare-utilization, mortality, and 1-year PROM improvement versus cemented TKA. Cementless fixation in TKA may provide value through higher MCID improvement in quality of life. Future episode-of-care cost-analyses and longer-term survivorship investigations are warranted.

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Conflict of interest statement

C.A.H. reports grants from Stryker, grants and personal fees from KCI, grants from Ferring Pharmaceuticals, grants from CD Diagnostics, grants from OREF, grants from Orthofix, grants from Lyfstone, grants from Zimmer Biomet, outside the submitted work. N.W.M. reports personal fees from Stryker Orthopaedics, personal fees from KCI Acelity, personal fees from Bone Support, outside the submitted work. T.G.M. reports personal fees from Zimmer Biomet, outside the submitted work. P.D.P. reports personal fees from Stryker, personal fees from Zimmer-Biomet, outside the submitted work. N.S.P. reports other from ISCT, other from Orthopaedic Research Society, other from Zimmer, outside the submitted work. G.J.S. reports other from Oberd, during the conduct of the study. Rest of the authors do not report any conflicts of interests.