Cementless fixation in medial unicompartmental knee arthroplasty: a systematic review

  • S. CampiEmail author
  • H. G. Pandit
  • C. A. F. Dodd
  • D. W. Murray



The aim of this study was to evaluate clinical outcome, failures, implant survival, and complications encountered with cementless fixation in unicompartmental knee arthroplasty (UKA).


A systematic review of the literature on cementless fixation in UKA was performed according to the PRISMA guidelines. The following database was comprehensively searched: PubMed, Cochrane, Medline, CINAHL, Embase, and Google Scholar. The keywords “unicompartmental”, “unicondylar”, “partial knee arthroplasty”, and “UKA” were combined with each of the keyword “uncemented”, “cementless” and “survival”, “complications”, and “outcome”. The following data were extracted: demographics, clinical outcome, details of failures and revisions, cumulative survival, and complications encountered. The risk of bias of each study was estimated with the MINORS score and a further scoring system based on the presence of the primary outcomes.


From a cohort of 63 studies identified using the above methodology, 10 papers (1199 knees) were included in the final review. The mean follow-up ranged from 2 to 11 years (median 5 years). The 5-year survival ranged from 90 to 99 % and the 10-year survival from 92 to 97 %. There were 48 revisions with an overall revision rate of 0.8 per 100 observed component-years. The most common cause of failure was progression of osteoarthritis in the retained compartment (0.9 %). The cumulative incidence of complications and revisions was comparable to that reported in similar studies on cemented UKAs. The advantages of cementless fixation include faster surgical time, avoidance of cementation errors, and lower incidence of radiolucent lines.


Cementless fixation is a safe and effective alternative to cementation in medial UKA. Clinical outcome, failures, reoperation rate, and survival are similar to those reported for cemented implants with lower incidence of radiolucent lines.

Level of evidence



Unicompartmental knee arthroplasty Cementless Partial knee arthroplasty UKA 



Anteromedial osteoarthritis


Confidence intervals


Knee Society Score


Not reported




Oxford Knee Score


Oxford unicompartmental knee arthroplasty


Randomised controlled trial


Radiolucent lines


Radiostereometric analysis


Standard deviation


Total knee arthroplasty


Unicompartmental knee arthroplasty



The authors would like to thank T.W. Hamilton, B.E. Marks, J. Brown, and J. Ferris for their assistance with this study.

Compliance with ethical standards

Conflict of interest

Some of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. In addition, benefits have been or will be directed to a research fund, foundation, educational institution, or other non-profit organisation with which one or more of the authors are associated.


  1. 1.
    Akan B, Karaguven D, Guclu B, Yildirim T, Kaya A, Armangil M, Cetin I (2013) Cemented versus uncemented Oxford unicompartmental knee arthroplasty: Is there a difference? Adv Orthop 2013:245915CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Bergenudd H (1995) Porous-coated anatomic unicompartmental knee arthroplasty in osteoarthritis: a 3- to 9-year follow-up study. J Arthroplasty 10:8–13CrossRefGoogle Scholar
  3. 3.
    Bernasek TL, Ja Rand, Bryan RS (1988) Unicompartmental porous coated anatomic total knee arthroplasty. Clin Orthop Relat Res 236:52–59Google Scholar
  4. 4.
    Blunn GW, Joshi AB, Lilley PA, Engelbrecht E, Ryd L, Lidgren L, Hardinge K, Nieder E, Walker PS (1992) Polyethylene wear in unicondylar knee prostheses. 106 retrieved Marmor, PCA, and St Georg tibial components compared. Acta Orthop Scand 63(3):247–255CrossRefPubMedGoogle Scholar
  5. 5.
    Clarius M, Haas D, Aldinger PR, Jaeger S, Jakubowitz E, Seeger JB (2010) Periprosthetic tibial fractures in unicompartmental knee arthroplasty as a function of extended sagittal saw cuts: an experimental study. Knee 17(1):57–60CrossRefPubMedGoogle Scholar
  6. 6.
    de Vos-Kerkhof E, Geurts DH, Wiggers M, Moll HA, Oostenbrink R (2016) Tools for ‘safety netting’ in common paediatric illnesses: a systematic review in emergency care. Arch Dis Child 101(2):131–139CrossRefPubMedGoogle Scholar
  7. 7.
    Forsythe ME, Englund RE, Leigton RK (2000) Unicondylar knee arthroplasty: a cementless perspective. Can J Surg 43(6):417–424PubMedPubMedCentralGoogle Scholar
  8. 8.
    Goodfellow J, O’Connor J, Pandit HG, Dodd CAF, Murray DW (2015) Unicompartmental arthroplasty with the Oxford knee, 2nd edn. Goodfellow Publishers, Oxford University Press, OxfordGoogle Scholar
  9. 9.
    Gulati A, Chau R, Pandit HG, Gray H, Price AJ, Dodd CA, Murray DW (2009) The incidence of physiological radiolucency following Oxford unicompartmental knee replacement and its relationship to outcome. J Bone Joint Surg Br 91(7):896–902CrossRefPubMedGoogle Scholar
  10. 10.
    Hall MJ, Da Connell, Morris HG (2013) Medium to long-term results of the UNIX uncemented unicompartmental knee replacement. Knee 20:328–331CrossRefPubMedGoogle Scholar
  11. 11.
    Harilainen A, Sandein J, Ylinen P, Vahvanen V (1993) Revision of the PCA unicompartmental knee. Acta Orthop Scand 64:428–430CrossRefPubMedGoogle Scholar
  12. 12.
    Hooper GJ, Maxwell AR, Wilkinson B, Mathew J, Woodfield TBF, Penny ID, Burn PJ, Frampton C (2012) The early radiological results of the uncemented Oxford medial compartment knee replacement. J Bone Joint Surg Br 94(3):334–338CrossRefPubMedGoogle Scholar
  13. 13.
    Hooper N, Snell D, Hooper G, Maxwell R, Frampton C (2015) The five-year radiological results of the uncemented Oxford medial compartment knee arthroplasty. Bone Joint J 97-B:1358–1363CrossRefPubMedGoogle Scholar
  14. 14.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14Google Scholar
  15. 15.
    Jeer PJS, Keene GCR, Gill P (2004) Unicompartmental knee arthroplasty: an intermediate report of survivorship after the introduction of a new system with analysis of failures. Knee 11:369–374CrossRefPubMedGoogle Scholar
  16. 16.
    Kendrick BJ, James AR, Pandit H, Gill HS, Price AJ, Blunn GW, Murray DW (2012) Histology of the bone-cement interface in retrieved Oxford unicompartmental knee replacements. Knee 19(6):918–922CrossRefPubMedGoogle Scholar
  17. 17.
    Kendrick BJL, Kaptein BL, Valstar ER, Gill HS, Jackson WFM, Dodd CAF, Price AJ, Murray DW (2015) Cemented versus cementless Oxford unicompartmental knee arthroplasty using radiostereometric analysis: a randomised controlled trial. Bone Joint J 97-B:185–191CrossRefPubMedGoogle Scholar
  18. 18.
    Kim SJ, Postigo R, Koo S, Kim JH (2014) Causes of revision following Oxford phase 3 unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22(8):1895–1901CrossRefPubMedGoogle Scholar
  19. 19.
    Kwong LM, Nielsen ES, Ruiz DR, Hsu AH, Dines MD, Mellano CM (2014) Cementless total knee replacement fixation: a contemporary durable solution–affirms. Bone Joint J 96-B(11A):87–92CrossRefPubMedGoogle Scholar
  20. 20.
    Labek G, Frischhut S, Schlichtherle R, Williams A, Thaler M (2011) Outcome of the cementless Taperloc stem: a comprehensive literature review including arthroplasty register data. Acta Orthop 82(2):143–148CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lecuire F, Berard JB, Martres S (2014) Minimum 10-year follow-up results of ALPINA cementless hydroxyapatite-coated anatomic unicompartmental knee arthroplasty. Eur J Orthop Surg Traumatol 24(3):385–394CrossRefPubMedGoogle Scholar
  22. 22.
    Liddle AD, Pandit H, Murray DW, CaF Dodd (2013) Cementless unicondylar knee arthroplasty. Orthop Clin North Am 44:261–269CrossRefPubMedGoogle Scholar
  23. 23.
    Liddle AD, Pandit H, O’Brien S, Doran E, Penny ID, Hooper GJ, Burn PJ, Dodd CAF, Beverland DE, Maxwell AR, Murray DW (2013) Cementless fixation in Oxford unicompartmental knee replacement: a multicentre study of 1000 knees. Bone Joint J 95-B:181–187CrossRefPubMedGoogle Scholar
  24. 24.
    Lindstrand A, Stenstrom A (1992) Polyethylene wear of the PCA unicompartmental knee. Prospective 5 (4–8) year study of 120 arthrosis knees. Acta Orthop Scand 63(3):260–262CrossRefPubMedGoogle Scholar
  25. 25.
    Lindstrand A, Stenstrom A, Egund N (1988) The PCA unicompartmental knee. A 1–4-year comparison of fixation with or without cement. Acta Orthop Scand 59(6):695–700CrossRefPubMedGoogle Scholar
  26. 26.
    Lindstrand A, Stenstrom A, Lewold S (1992) Multicenter study of unicompartmental knee revision. Acta Orthop Scand 63(3):256–259CrossRefPubMedGoogle Scholar
  27. 27.
    Magnussen PA, Bartlett RJ (1990) Cementless PCA unicompartmental joint arthroplasty for osteoarthritis of the knee. A prospective study of 51 cases. J Arthroplasty 5(2):151–158CrossRefPubMedGoogle Scholar
  28. 28.
    Nakama GY, Peccin MS, Almeida GJ, Lira Neto Ode A, Queiroz AA, Navarro RD (2012) Cemented, cementless or hybrid fixation options in total knee arthroplasty for osteoarthritis and other non-traumatic diseases. Cochrane Database Syst Rev 10:CD006193PubMedGoogle Scholar
  29. 29.
    Pabinger C, Berghold A, Boehler N, Labek G (2013) Revision rates after knee replacement. Cumulative results from worldwide clinical studies versus joint registers. Osteoarthritis Cartilage 21(2):263–268CrossRefPubMedGoogle Scholar
  30. 30.
    Pandit H, Jenkins C, Beard DJ, Gallagher J, Price AJ, CaF Dodd, Goodfellow JW, Murray DW (2009) Cementless Oxford unicompartmental knee replacement shows reduced radiolucency at one year. J Bone Joint Surg Br 91:185–189CrossRefPubMedGoogle Scholar
  31. 31.
    Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW (2011) Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br 93(2):198–204CrossRefPubMedGoogle Scholar
  32. 32.
    Pandit H, Liddle AD, Kendrick BJL, Jenkins C, Price AJ, Gill HS, Dodd CA, Murray DW (2013) Improved fixation in cementless unicompartmental knee replacement: five-years results of a randomised controlled trial. J Bone Joint Surg Am 95(15):1365–1372CrossRefPubMedGoogle Scholar
  33. 33.
    Pandit HG, Campi S, Hamilton TW, Dada OD, Pollalis S, Jenkins C, Dodd CA, Murray DW (2015) Five-year experience of cementless Oxford unicompartmental knee replacement. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-015-3879-y Google Scholar
  34. 34.
    Rudol G, Jackson MP, James SE (2007) Medial tibial plateau fracture complicating unicompartmental knee arthroplasty. J Arthroplasty 22(1):148–150CrossRefPubMedGoogle Scholar
  35. 35.
    Sabah SA, Henckel J, Koutsouris S, Rajani R, Hothi H, Skinner JA, Hart AJ (2016) Are all metal-on-metal hip revision operations contributing to the National Joint Registry implant survival curves?: a study comparing the London Implant Retrieval Centre and National Joint Registry datasets. Bone Joint J 98-b(1):33–39CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Schlueter-Brust K, Kugland K, Stein G, Henckel J, Christ H, Eysel P, Bontemps G (2014) Ten year survivorship after cemented and uncemented medial Uniglide® unicompartmental knee arthroplasties. Knee 21:964–970CrossRefPubMedGoogle Scholar
  37. 37.
    Seeger JB, Haas D, Jager S, Rohner E, Tohtz S, Clarius M (2012) Extended sagittal saw cut significantly reduces fracture load in cementless unicompartmental knee arthroplasty compared to cemented tibia plateaus: an experimental cadaver study. Knee Surg Sports Traumatol Arthrosc 20(6):1087–1091CrossRefPubMedGoogle Scholar
  38. 38.
    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73(9):712–716CrossRefPubMedGoogle Scholar
  39. 39.
    Svard UC, Price AJ (2001) Oxford medial unicompartmental knee arthroplasty. A survival analysis of an independent series. J Bone Joint Surg Br 83(2):191–194CrossRefPubMedGoogle Scholar
  40. 40.
    Swank M, Stulberg SD, Jiganti J, Machairas S (1993) The natural history of unicompartmental arthroplasty. An eight-year follow-up study with survivorship analysis. Clin Orthop Relat Res 286:130–142Google Scholar
  41. 41.
    Van Loon P, de Munnynck B, Bellemans J (2006) Periprosthetic fracture of the tibial plateau after unicompartmental knee arthroplasty. Acta Orthop Belg 72(3):369–374PubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • S. Campi
    • 1
    • 2
    Email author
  • H. G. Pandit
    • 1
    • 2
  • C. A. F. Dodd
    • 2
  • D. W. Murray
    • 1
    • 2
  1. 1.Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordOxfordUK
  2. 2.Nuffield Orthopaedic Centre, Oxford University HospitalNHS Foundation TrustOxfordUK

Personalised recommendations