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No difference between cemented and cementless total knee arthroplasty in young patients: a review of the evidence

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The present piece of work provides improved knowledge about the evidence related to TKA in patients 60 years of age or younger, with special focus on fixation methods. Main concern of the review is to analyse the difference of survival rate and complications of cemented and cementless implants.

Methods

An electronic search was carried out between October and December 2015, through CINAHL, PubMed and the Cochrane Central Registry of Controlled Trials web databases. Articles in English, Italian, French and Spanish were considered for inclusion. Only peer-reviewed studies with adult patients aged 60 years or less, with diagnosis of osteoarthritis in more than 90% of the subjects, were considered for inclusion. All studies had to report outcomes after TKA with either cemented or cementless fixation technique.

Results

No significant differences in terms of clinical, functional and radiological outcomes were found between cemented and cementless implants. Good clinical and functional results were obtained in terms of the Knee Society score and Western Ontario and McMaster Universities Osteoarthritis Index for both techniques. Radiographic results showed that radiolucent lines of <2 mm in width were detected at radiographs, without difference between cemented or cementless implants. Well-conducted trials on cemented versus cementless TKA were carried out in few papers. A survival rate of over 90% was reported in the majority of the studies at a mean follow-up of 8.6 years (range 5–18 years).

Conclusion

Similar results were observed in terms of functional outcome and survival rates for both cemented and cementless TKAs. High survival rates were reported for both operative techniques and cemented TKA did not offer additional benefit. Assuming that cementless prosthesis allows a stable fixation and reduces the time of operation, the authors recommend the cementless fixation as a primary choice in the investigated patient population. However, evidence is low, and further research is needed.

Level of evidence

IV.

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Author’s contribution

EF and GT carried out the review process, and wrote a first draft of the text. FF, JK, KS and ORA supervised the whole work and revised the text before submission.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy

    Edoardo Franceschetti, Guglielmo Torre, Alessio Palumbo, Rocco Papalia & Francesco Franceschi

  2. Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Jón Karlsson & Kristian Samuelsson

  3. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Olufemi R. Ayeni

Authors
  1. Edoardo Franceschetti
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  2. Guglielmo Torre
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  3. Alessio Palumbo
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  4. Rocco Papalia
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  5. Jón Karlsson
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  6. Olufemi R. Ayeni
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  7. Kristian Samuelsson
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  8. Francesco Franceschi
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Corresponding author

Correspondence to Edoardo Franceschetti.

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The authors declare that they have no conflict of interest.

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There is no funding source.

Ethical approval

The present study has been carried out according to Good Clinical Practice principles and did not involve any human subject for sperimentation purpose.

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Franceschetti, E., Torre, G., Palumbo, A. et al. No difference between cemented and cementless total knee arthroplasty in young patients: a review of the evidence. Knee Surg Sports Traumatol Arthrosc 25, 1749–1756 (2017). https://doi.org/10.1007/s00167-017-4519-5

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  • DOI: https://doi.org/10.1007/s00167-017-4519-5

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