Skip to main content

Cementless Total Knee Arthroplasty

  • Chapter
Knee Arthroplasty Handbook

Conclusions

Recent reports with up to 10-year clinical follow-up have demonstrated that cementless total knee arthroplasty can yield excellent results in young, active patients when sound implant design principles and surgical techniques are followed. Intimate apposition of the prosthesis to host bone is achieved with instrumentation that allows precise bone resection, and by the routine application of morselized autogenous bone chips to the cut surfaces. Revision of cementless total knee components without porous-coated pegs, keels, or stems has proven to be bone-sparing, which is an important consideration in the younger patient who may outlive their prosthesis. The authors believe that cementless fixation is a superior alternative to cemented fixation for primary total knee arthroplasty in younger patients with higher functional demands and good bone stock.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  1. Hungerford DS, Krakow KA. Total joint arthroplasty of the knee. Clin Orthop. 1985; 192:23–33.

    PubMed  Google Scholar 

  2. Moreland JR. Mechanisms of failure in total knee arthroplasty. Clin Orthop. 1988; 226:49–64.

    PubMed  Google Scholar 

  3. Ranawat CS, Johanson NA, Rimnac CM, Wright TM, Schwartz RE. Retreival analysis of porous-coated components for total knee arthroplasty. A report of two cases. Clin Orthop. 1986; 209:244–248.

    PubMed  Google Scholar 

  4. Insall JN, Hood RW, Flawn LB, Sullivan DJ. The total knee prosthesis in gonarthrosis. A five-to nine-year follow-up of the first one hundred consecutive replacements. J Bone Joint Surg. 1983; 65A:619–628.

    Google Scholar 

  5. Anderson H, Carsten E, Frandsen P. Polyethylene failure of metal-backed patellar components. Acta Orthop Scand. 1991; 62:1–3.

    Google Scholar 

  6. Baech J, Kofoed H. Failure of metal-backed patellar arthroplasty. Acta Orthop Scand. 1991; 62:166–168.

    Article  CAS  PubMed  Google Scholar 

  7. Bayley JC, Scott R, Ewald F, Holmes G. Failure of the metal-backed patellar component after total knee replacement. J Bone Joint Surg. 1988; 70-A:668–673.

    Google Scholar 

  8. Lombardi A, Engh G, Volz R, Albrigo J. Fracture/dissociation of the polyethylene in metal-backed patellar components in total knee arthroplasty. J Bone Joint Surg. 1988; 70-A:675–679.

    Google Scholar 

  9. Rosenberg A, Andriacci T, Barden R, Galante JO. Patellar component failure in total knee arthroplasty. Clin Orthop. 1988; 236:106–114.

    PubMed  Google Scholar 

  10. Stulberg D, Stulberg B, Hamati Y, Tsao A. Failure mechanisms of metal-backed patellar components. Clin Orthop. 1988; 236:88–105.

    PubMed  Google Scholar 

  11. Davies JP, Jasty M, O’Conner DO, Burke DW, Harrigan TP, Harris WH. The effect of centrifuging bone cement. J Bone Joint Surg. 1989; 71B:39–42.

    Google Scholar 

  12. Miller J. Fixation in total knee arthroplasty. In: Insall J, ed. Surgery of the Knee. New York: Churchill Livingstone; 1984:717–728.

    Google Scholar 

  13. Whiteside LA. Cementless total knee replacement. Nineto eleven-year results and 10-year survivorship analysis. Clin Orthop. 1994; 309:185–192.

    PubMed  Google Scholar 

  14. Laskin RS. Tricon-M uncemented total knee arthroplasty. A review of 96 cases followed for longer than two years. J Arthroplasty. 1988; 3:27–38.

    Article  CAS  PubMed  Google Scholar 

  15. Rosenberg AG, Barden RM, Galante JO. Cemented and ingrowth fixation of the Miller-Galante prosthesis. Clinical and roentgenographic comparison after three-to six-year follow-up studies. Clin Orthop. 1990;260:71–79.

    PubMed  Google Scholar 

  16. Mont MA, Mathur SK, Krakow KA, Loewy JW, Hungerford DS. Cementless total knee arthroplasty in obese patients. A comparison with a matched control group. J Arthroplasty. 1996; 11:153–156.

    Article  CAS  PubMed  Google Scholar 

  17. Whiteside LA. Fixation for primary total knee arthroplasty: cementless. J Arthroplasty. 1996; 11:125–127.

    Article  CAS  PubMed  Google Scholar 

  18. Jones LC, Hungerford DS. Cement disease. [Review]. Clinical Orthopaedics & Related Research. 1987; 225:192–206.

    Google Scholar 

  19. Leland RH, Hofmann AA, Bachus KN, Bloebaum RD. Biocompatibility and bone response of human osteoarthritic cancellous bone to a titanium porous-coated cobalt chromium cylinder. Transactions of the Society for Biomaterials. 1991; 14:153 (abstract).

    Google Scholar 

  20. Hofmann AA. Response of human cancellous bone to identically structured commercially pure titanium and cobalt chromium alloy porous coated cylinders. Clin Mater. 1993; 14:101–115.

    Article  CAS  Google Scholar 

  21. Bloebaum RD, Bachus KN, Mitchell W, Hoffman G, Hofmann AA. Analysis of the bone surface area in resected tibia. Implications in tibial component subsidence and fixation. Clin Orthop. 1994; 309:2–10.

    PubMed  Google Scholar 

  22. Bloebaum RD, Bachus KN, Momberger NG, Hofmann AA. Mineral apposition rates of human cancellous bone at the interface of porous coated implants. J Biomed Mater Res. 1994; 28:537–544.

    Article  CAS  PubMed  Google Scholar 

  23. Bloebaum RD, Rhodes DM, Rubman MH, Hofmann AA. Bilateral tibial components of different cementless designs and materials: microradiographic, backscattered imaging, and histologic analysis. Clin Orthop. 1991; 268:179–187.

    PubMed  Google Scholar 

  24. Bloebaum RD, Rubman MH, Hofmann AA. Bone ingrowth into porous-coated tibial components implanted with autograft bone chips: analysis of ten consecutively retrieved implants. J Arthroplasty. 1992; 7:483–493.

    CAS  PubMed  Google Scholar 

  25. Hofmann AA, Bloebaum RD, Rubman MH, Bachus KN, Plaster R. Microscopic analysis of autograft bone applied at the interface of porous-coated devices in human cancellous bone. Int Orthop. 1992; 16:349–358.

    Article  CAS  PubMed  Google Scholar 

  26. Krug WH, Johnson JA, Souaid DJ, Miller JE, Ahmed AM. Anthropomorphic studies of the proximal tibia and their relationship to the design of knee implants. Trans Orthop Res Soc. 1983; 8:402 (abstract).

    Google Scholar 

  27. Branson PJ, Steege J, Wixson RL, Stulberg SD. Rigidity of initial fixation in noncemented total knee tibial components. Trans Orthop Res Soc. 1987; 12:293 (abstract).

    Google Scholar 

  28. Dupont JA, Weinstein AM, Townsend PR. Tibial plateau coverage in total knee replacement. Tenth Annual Meeting Society for Biomaterials 1984; Washington, DC (abstract).

    Google Scholar 

  29. Westrich GH, Haas SB, Insall JN, Frachie A. Resection specimen analysis of proximal tibial anatomy based on 100 total knee arthroplasty specimens. J Arthroplasty. 1995; 10:47–51.

    CAS  PubMed  Google Scholar 

  30. Lee RW, Volz RG, Sheridan DC. The role of fixation and bone quality on the mechanical stability of tibial knee components. Clin Orthop. 1991; 273:177–183.

    PubMed  Google Scholar 

  31. Evanich CJ, Tkach TK, von Glinski S, Camargo MP, Hofmann AA. Six to ten year experience using countersunk metal-backed patellae. J Arthroplasty. 1996; In Press.

    Google Scholar 

  32. Moreland JR, Bassett LW, Hanker GJ. Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg. 1987; 69-A:745–749.

    Google Scholar 

  33. Krakow KA. The Technique of Total Knee Arthroplasty. St. Louis: C.V. Mosby; 1990:118–137.

    Google Scholar 

  34. Hofmann AA, Bachus KN, Wyatt RWB. Effect of the tibial cut on subsidence following total knee arthroplasty. Clin Orthop. 1991; 269:63–69.

    PubMed  Google Scholar 

  35. Bachus KN, Harman MK, Bloebaum RD. Stereoscopic analysis of trabecular bone orientation in proximal human tibias. Cells Mater. 1992; 2:13–20.

    Google Scholar 

  36. Andriacchi TP, Galante JO, Rermier RW. The influence of total knee replacement design on walking and stair climbing. J Bone Joint Surg. 1982; 64-A:1328–1335.

    Google Scholar 

  37. Ewald FC, Jacobs MA, Miegel RE. Kinematic total knee replacement. J Bone Joint Surg. 1984; 66-A:1032–1040.

    Google Scholar 

  38. Kelman GJ, Biden EN, Wyatt MP, Ritter MA, Colwell CW. Gait laboratory analysis of a posterior cruciate-sparing total knee arthroplasty in stair ascent and descent. Clin Orthop. 1989; 248:21–25.

    PubMed  Google Scholar 

  39. Ranawat CS, Hansraj KK. Effect of posterior cruciate sacrifice on durability of cement-bone interface. Orthop Clin N Amer. 1989; 20:63–69.

    CAS  Google Scholar 

  40. Dorr LD, Ochsner JL, Gronley J. Functional comparison of posterior cruciate-retained versus cruciate-sacrificed total knee arthroplasty. Clin Orthop. 1988; 236:36–43.

    PubMed  Google Scholar 

  41. Shoji H, Wolf A, Packard S, Yoshino S. Cruciate-retained and excised total knee arthroplasty. Clin Orthop. 1994; 305:218–222.

    PubMed  Google Scholar 

  42. Insall JN, Lachiewcz PF, Burstein AH. The posterior stabilized condylar prosthesis: a modification of the total condylar design. J Bone Joint Surg. 1982; 64-A:1317–1323.

    Google Scholar 

  43. Scott WN, Rubenstein M, Scuderi G. Results after knee replacement with a posterior cruciate-sparing prosthesis. J Bone Joint Surg. 1988; 70-A:1163–1173.

    Google Scholar 

  44. Scuderi GR, Insall JN. The posterior stabilized knee prosthesis. Orthop Clin N Amer. 1989; 20:71.

    CAS  Google Scholar 

  45. Hofmann AA, Tkach TK, Evanich CJ, Camargo MP. Posterior stabilization in total knee arthroplasty with use of an ultracongruent polyethylene insert. Orthopedic Transactions. 1996; (abstract).

    Google Scholar 

  46. Cameron HU, Federhow DM. The patella in total knee arthroplasty. Clin Orthop. 1982; 165:196–199.

    Google Scholar 

  47. Clayton ML, Thirpathy R. Patellar complications after total condylar arthroplasty. Clin Orthop. 1982; 170:152–155.

    PubMed  Google Scholar 

  48. Brick GW, Scott RD. The patellofemoral component of total knee arthroplasty. Clin Orthop. 1988; 231:163–178.

    PubMed  Google Scholar 

  49. Anouchi YS, Whiteside LA, Kaiser AD, Milliano MR. The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens. Clin Orthop. 1993; 287:170–177.

    PubMed  Google Scholar 

  50. Briard JL, Hungerford DS. Patellofemoral instability in total knee arthroplasty. J Arthroplasty. 1989; S87–S97.

    Google Scholar 

  51. Grace JN, Rand JA. Patellar instability after total knee arthroplasty. Clin Orthop. 1988; 237:184–189.

    PubMed  Google Scholar 

  52. Merkow RL, Soudry M, Insall JN. Patellar dislocation following total knee replacement. J Bone Joint Surg. 1985; 67-A:1321–1327.

    Google Scholar 

  53. Nagamine R, Whiteside LA, White JE, McCarthy DS. Patellar tracking after total knee arthroplasty: the effect of tibial tray malrotation and articular surface configuration. Clin Orthop. 1994; 304:263–271.

    Google Scholar 

  54. Rhoads DD, Noble PC, Reuben JD, Mahoney OM, Tullos HS. The effect of femoral component position on patellar tracking after total knee arthroplasty. Clin Orthop. 1990; 260:43.

    PubMed  Google Scholar 

  55. Hofmann AA, Tkach TK, Evanich CJ, Camargo MP, Zhang Y. Patellar component medialization in total knee arthroplasty. J Arthroplasty. 1997; 12(5):155–160.

    Article  CAS  PubMed  Google Scholar 

  56. Hofmann AA, Plaster RL, Murdock LE. Subvastus (southern) approach for primary total knee arthroplasty. Clin Orthop. 1991; 269:70–77.

    PubMed  Google Scholar 

  57. Krause WL. Temperature elevations in orthopaedic cutting operations. J Biomech. 1982; 15:267–275.

    Article  CAS  PubMed  Google Scholar 

  58. Scott RD, Santore RF. Unicompartmental replacement for osteoarthritis of the knee. J Bone Joint Surg. 1981; 63A:536–544.

    Google Scholar 

  59. Collins DN, Heim SA, Nelson CL, Smith P. Porous-coated anatomic total knee arthroplasty. A prospective analysis comparing cemented and cementless fixation. Clin Orthop. 1991; 267:128–136.

    PubMed  Google Scholar 

  60. Buechel FF, Pappas MJ. Long-term survivorship analysis of cruciate-sparing versus cruciate-sacrificing knee prostheses using meniscal bearings. Clin Orthop. 1990; 260:162–169.

    PubMed  Google Scholar 

  61. Beuchel FF. Cementless meniscal bearing knee arthroplasty: 7-to 12-year outcome analysis. Orthopedics. 1994; 17:833–836.

    Google Scholar 

  62. Tkach TK, Evanich CJ, Hofmann AA, Camargo MP, Zhang Y. Six to ten year follow-up with cementless fixation. Orthopedic Transactions. 1996; (abstract).

    Google Scholar 

  63. Magee FP, Weinstein AM. The effect of position on the detection of radiolucent lines beneath the tibial tray. Trans Orthop Res Soc. 1986; 11:357 (abstract).

    Google Scholar 

  64. Mintz AD, Pilkington CA, Dip T, Howie DW. A comparison of plain and fluoroscopically guided radiographs in the assessment of total knee arthroplasty. J Bone Joint Surg. 1989; 71A:1343–1347.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Springer Science+Business Media, Inc.

About this chapter

Cite this chapter

Hofmann, A.A., Scott, D.F. (2006). Cementless Total Knee Arthroplasty. In: Scuderi, G.R., Tria, A.J. (eds) Knee Arthroplasty Handbook. Springer, New York, NY. https://doi.org/10.1007/0-387-33531-5_7

Download citation

  • DOI: https://doi.org/10.1007/0-387-33531-5_7

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-30730-5

  • Online ISBN: 978-0-387-33531-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics