International Orthopaedics

, Volume 38, Issue 2, pp 297–303

Cementless and cemented total knee arthroplasty in patients younger than fifty five years. Which is better?

  • Young-Hoo Kim
  • Jang-Won Park
  • Hyung-Mook Lim
  • Eun-Soo Park
Original Paper



The purpose of this prospective, randomised study was to evaluate long-term clinical results, radiographic findings, complications and revision and survivorship rates in patients <55 years at a minimum of 16 years after undergoing bilateral, sequential, simultaneous, cemented and cementless total knee arthroplasties (TKAs) in the same patients.


Bilateral, sequential, simultaneous TKAs were performed in 80 patients (160 knees). There were 63 women and 17 men with a mean age of 54.3 years (range 49–55), who received a cementless prosthesis in one knee and a cemented prosthesis in the other. The mean follow-up was 16.6 years (range 16–17).


At final review, the mean Knee Society (KS) knee scores (95.8 versus 96.9), Western Ontario and McMaster Universities (WOMAC) osteoarthritis (OA) index (25.4 versus 25.9), range of motion (ROM) (125°versus 128°), patient satisfaction (8.1 versus 8.3) and radiological results were similar in both groups. Femoral component survival rate was 100 % in both groups at 17 years; at 17 years, the cemented tibial component survival rate was 100 % and the cementless tibial component 98.7 %. No osteolysis was identified in either group.


Long-term results of both cementless and cemented TKAs were encouraging in patients with OA who were <55 years. However, we found no evidence to prove the superiority of cementless over cemented TKAs.


Cementless Cemented Total knee arthroplasty Young patients 


  1. 1.
    Lombardi AV Jr, Berasi CC, Berend KR (2007) Evolution of tibial fixation in total knee arthroplasty. J Arthroplast 22(4 Suppl 1):25–29CrossRefGoogle Scholar
  2. 2.
    Bauer TW, Schils J (1999) The pathology of total joint arthroplasty. I: mechanisms of implant fixation. Skeletal Radiol 28(8):423–432PubMedCrossRefGoogle Scholar
  3. 3.
    Scuderi GR, Insall JN (1992) Total knee arthroplasty: current clinical perspective. Clin Orthop Relat Res 276:26–32PubMedGoogle Scholar
  4. 4.
    Kim Y-H, Kim J-S, Choe J-W, Kim H-J (2012) Long-term comparison of fixed-bearing and mobile-bearing total knee replacements in patients younger than fifty-one years of age with osteoarthritis. J Bone Joint Surg Am 94(10):866–873PubMedGoogle Scholar
  5. 5.
    Kim Y-H, Kim J-S, Park J-W, Joo J-H (2011) Comparison of the Low Contact Stress and Press Fit Condylar Rotating-Platform mobile-bearing prostheses in total knee arthroplasty: a prospective randomized study. J Bone Joint Surg Am 93(11):1001–1007PubMedGoogle Scholar
  6. 6.
    Naudie DD, Ammeen DJ, Engh GA, Rorabeck CH (2007) Wear and osteolysis around total knee arthroplasty. J Am Acad Orthop Surg 15(1):53–64PubMedGoogle Scholar
  7. 7.
    ƠRourke MR, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC (2002) Osteolysis associated with a cemented modular posterior –cruciate-substituting total knee design: five to eight- year follow-up. J Bone Joint Surg Am 84(8):1362–1371Google Scholar
  8. 8.
    Bassett RW (1998) Results of 1,000 performance Knees: cementless versus cemented fixation. J Arthroplasty 13(4):409–413PubMedCrossRefGoogle Scholar
  9. 9.
    Nolan JF, Bucknill TM (1992) Aggressive granulomatosis from polyethylene failure in an uncemented knee replacement. J Bone Joint Surg Br 74(1):23–24PubMedGoogle Scholar
  10. 10.
    Berry DJ, Wold LE, Rand JA (1993) Extensive osteolysis around an aseptic, stable, uncemented total knee replacement. Clin Orthop Relat Res 293:204–207PubMedGoogle Scholar
  11. 11.
    Albrektsson BE, Carlsson LV, Freeman MA, Herberts P, Ryd L (1992) Proximally cemented versus uncemented Freeman-Samuelson knee arthroplasty: a prospective randomized study. J Bone Joint Surg Br 74(2):233–238PubMedGoogle Scholar
  12. 12.
    Duffy GP, Crowder AR, Trousdale RR, Berry DJ (2007) Cemented total knee arthroplasty using a modern prosthesis in young patients with osteoarthritis. J Arthroplasty 22(6 Suppl 2):67–70PubMedCrossRefGoogle Scholar
  13. 13.
    Khaw FM, Kirk LM, Morris RW, Gregg PJ (2002) A randomised, controlled trial of cemented versus cementless press-fit condular total knee replacement: ten-year survival analysis. J Bone Joint Surg Br 84(5):658–666PubMedCrossRefGoogle Scholar
  14. 14.
    Baker PN, Khaw FM, Kirk LM, Esler CN, Gregg PJ (2007) A randomised controlled trial of cemented versus cementless press-fit condular total knee replacement: 15- year survival analysis. J Bone Joint Surg Br 89(12):1608–1614PubMedCrossRefGoogle Scholar
  15. 15.
    McCaskie AW, Deehan DJ, Green TP, Lock KR, Rhompson JR, Harper WM, Gregg PJ (1998) Randomised, prospective study comparing cemented and cementless total knee replacement: results of press-fit condylar total knee replacement at five years. J Bone Joint Surg Br 80(6):971–975PubMedCrossRefGoogle Scholar
  16. 16.
    Duffy GP, Berry DJ, Rand JA (1998) Cement versus cementless fixation in total knee arthroplasty. Clin Orthop Relat Res 356:66–72PubMedCrossRefGoogle Scholar
  17. 17.
    Park J-W, Kim Y-H (2011) Simultaneous cemented and cementless total knee replacement in the same patients: a prospective comparison of long-term outcome using an identical design of NexGen prosthesis. J Bone Joint Surg Br 93(11):1479–1486PubMedCrossRefGoogle Scholar
  18. 18.
    Ahlbäck S (1968) Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol Diagn (Stockh) 277(Supple):7–72Google Scholar
  19. 19.
    Insall JN, Dorr LD, Scott RD, Scott RN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14PubMedGoogle Scholar
  20. 20.
    Belllamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patient with osteoarthritis of the hip or knee. J Rheumatol 15(2):1833–1840Google Scholar
  21. 21.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  22. 22.
    Kaplan EL, Meier P (1977) Nonparametric estimation from incomplete observations. JSTOR 53 (282):457–481Google Scholar
  23. 23.
    Greenwood M (1926) The natural duration of cancer: Reports on public health and medical subjects. Her Majesty’s stationery office, London, pp 1–26Google Scholar
  24. 24.
    Diduch DR, Insall JN, Scott WN, Scuderi GR, Font-Rodriguez D (1997) Total knee replacement in young, active patients. Long-term follow-up and functional outcome. J Bone Joint Surg Am 79(4):575–582PubMedGoogle Scholar
  25. 25.
    Dixon MC, Brown RR, Parsch D, Scott RD (2005) Modular fixed-bearing total knee arthroplasty with retention of the posterior cruciate ligament. A study of patients followed for a minimum of fifteen years. J Bone Joint Surg Am 87(3):598–603PubMedCrossRefGoogle Scholar
  26. 26.
    Dalury DF, Barrett WP, Mason JB, Goldstein WM, Murphy JA, Roche MW (2008) Midterm survival of a contemporary modular total knee replacement: a multicenter study of 1970 knees. J Bone Joint Surg Br 90(12):1594–1596PubMedCrossRefGoogle Scholar
  27. 27.
    Kim Y-H, Choi Y, Kim JS (2010) Osteolysis in well functioning fixed-and mobile-bearing TKAs in Younger patients. Clin Orthop Relat Res 468(11):3084–3093PubMedCrossRefGoogle Scholar
  28. 28.
    Emmerson KP, Moran CG, Pinder IM (1996) Survivorship analysis of the kinematic stabilizer total knee replacement: a 10-to 14-year follow-up. J Bone Joint Surg Br 78(3):441–445PubMedGoogle Scholar
  29. 29.
    Ritter MA, Worland R, Saliski J, Helphenstine JV, Edmondson KL, Keating EM, Faris PM, Meding JB (1995) Flat-on-flat, nonconstrained, compression molded polyethylene total knee replacement. Clin Orthop Relat Res 321:79–85PubMedGoogle Scholar
  30. 30.
    Nafei A, Kristensen O, Knudsen HM, Hvid I, Jensen J (1996) Survivorship analysis of cemented total condylar knee arthroplasty : a long-term follow-up report on 348 cases. J Arthroplasty 11:7–10PubMedCrossRefGoogle Scholar
  31. 31.
    Ranawat CS, Flynn WF Jr, Saddler S, Hansrai KK, Maynard MJ (1996) Long-term results of the total condylar knee arthroplasty: a 15-years survivorship study. Clin Orthop Relat Res 286:94–102Google Scholar
  32. 32.
    Hofmaan AA, Evanich JD, Ferguson RP, Camargo MP (2001) Ten-to 14- year clinical followup of the cementless Natural Knee System. Clin Orthop Relat Res 388:85–94CrossRefGoogle Scholar
  33. 33.
    Ritter MA, Meneghini RM (2010) Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty. J Arthroplasty 25(4):507–513PubMedCrossRefGoogle Scholar
  34. 34.
    Schrøder HM, Berthelsen A, Hassani G, Hansen EB, Solgaard S (2001) Cementless porous-coated total knee arthroplasty: 10-year results in a consecutive series. J Arthroplasty 16(5):559–567PubMedCrossRefGoogle Scholar
  35. 35.
    Whiteside LA (1994) Cementless total knee replacement: nine-to 11-year results and 10-year survivorship analysis. Clin Orthop Relat Res 309:185–192PubMedGoogle Scholar
  36. 36.
    Oliver MC, Keast-Butler OD, Hinves BL, Shepperd JA (2005) A hydroxyapatite-coated Insall-Burstein II total knee replacement: 11-year results. J Bone Joint Surg Br 87(4):478–482PubMedCrossRefGoogle Scholar
  37. 37.
    Epinette JA, Manley MT (2007) Hydroxyapatite-coated total knee replacement: clinical experience at 10 to 15 years. J Bone Joint Surg Br 89(1):34–38PubMedCrossRefGoogle Scholar
  38. 38.
    Rand JA (1991) Cement or cementless fixation in total knee arthroplasty? Clin Orthop Relat Res 273:52–62PubMedGoogle Scholar
  39. 39.
    Rorabeck CH, Bourne RB, Nott L (1988) The cemented kinematic- II and the non-cemented porous-coated anatomic prostheses for total knee replacement. A prospective evaluation. J Bone Joint Surg Am 70(4):483–490PubMedGoogle Scholar
  40. 40.
    Collins DN, Heim SA, Nelson CL, Smith P 3rd (1991) Porous-coated anatomic total knee arthroplasty: a prospective analysis comparing cemented and cementless fixation. Clin Orthop Relat Res 267:128–136PubMedGoogle Scholar
  41. 41.
    Chockalingam S, Scott G (2000) The outcome of cemented vs cementless fixation of a femoral component in total knee replacement (TKR) with the identification of radiological signs for the prediction of failure. Knee 7(4):233–238Google Scholar
  42. 42.
    Onsten I, Nordqvist A, Carlsson AS, Besjakov J, Shott S (1998) Hydroxyapatite augmentation of the porous coating improves fixation of tibial components: a randomized RSA study in 116 patients. J Bone Joint Surg Br 80(3):417–425PubMedCrossRefGoogle Scholar
  43. 43.
    Berger RA, Lyon JH, Jacobs JJ, Barden RM, Berkson EM, Sheinkop MB, Rosenberg AG, Galante JO (2001) Problems with cementless total knee arthroplasty at 11 years followup. Clin Orthop Relat Res 392:196–207PubMedCrossRefGoogle Scholar
  44. 44.
    Gandhi R, Tsvetkov D, Davey JR, Mahomed NN (2009) Survival and clinical function of cemented and uncemented prostheses in total knee replacement: a meta-analysis. J Bone Joint Surg Br 91(7):889–895PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Young-Hoo Kim
    • 1
    • 2
  • Jang-Won Park
    • 1
  • Hyung-Mook Lim
    • 1
  • Eun-Soo Park
    • 1
  1. 1.The Joint Replacement Center, School of MedicineEwha Womans UniversitySeoulRepublic of Korea
  2. 2.The Joint Replacement CenterEwha Womans University MokDong HospitalSeoulRepublic of Korea

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