Global trends in fixation methods for primary total knee arthroplasty: An international registry-based analysis and review of outcomes

Abstract

Background: Despite the projected growth of total knee arthroplasty (TKA) in the United States (US) and worldwide, there remains debate regarding optimal implant fixation.

Purpose: The purpose of this study was to report the global trends in cementing rates for TKA using available data from national arthroplasty registries.

Methods: Data were extracted from the annual reports of 7 national joint registries, with annual trends in cementation rates calculated via linear regression. Data regarding revision rates were aggregated from national joint registries, and a literature search identified all meta-analyses published since 2012 that compared outcomes of cemented and cementless fixation.

Results: Average rates of cementless fixation over the study period ranged from 1.4 % (Germany) to 15.4 % (Australia). The US led in cementless TKA usage with rates increasing at a rate of 2 % annually (p<.001). In European countries, use of cementless fixation remains below 10 % with only Sweden showing increased adoption. Hybrid cementation is used less than cemented or cementless (<10 % of cases/year) in countries analyzed in this study except for Australia which reports upwards of 20 % of cases/year in 2022. Summary of meta-analyses revealed no clear differences in rates of revision, reoperation, infection, range of motion (ROM), or knee society score (KSS).

Conclusion: The vast majority of TKAs performed worldwide use cement fixation, but rates of cemented and cementless TKA fixation vary widely by country. Recent meta-analyses generally indicate cementless TKA provides similar outcomes when compared to cemented TKA. In contrast, registry data still associates cemented TKAs with lower revision rates.

Keywords: Cemented; Cementless; Fixation; Hybrid; Outcomes; Total knee arthroplasty; Uncemented.