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A prospective randomised controlled trial of cemented and uncemented tibial baseplates: functional and radiological outcomes

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

With the success of uncemented fixation in younger patients undergoing total hip arthroplasty and the growing demand for total knee arthroplasty (TKA) in a younger cohort of patients, there has been an increasing interest in cementless tibial baseplate fixation. We sought to determine whether there was a clear advantage to the use of three different forms of tibial baseplate fixation. The primary outcome of this study was survivorship and secondary outcomes were functional and radiological outcomes, up until 10 years.

Materials and methods

We conducted a randomised controlled trial and recruited 224 patients with 274 knees. Patients underwent TKA by a single surgeon utilising a standard surgical technique. All patients received a cruciate retaining TKA with a cementless femoral component, and were randomised to receive either a cemented tibial component, a pegged porous coated cementless tibial component with screws or a cementless tantalum monoblock tibial component with pegs. Patient reported outcome measures (PROMS), radiological data and survivorship were assessed until 10 years post-operatively.

Results

Pre-operative range of motion, alignment and PROMS were similar between the three groups. The use of cemented, cementless with screws or cementless with pegs fixation options, lead to differences in functional outcomes. There was greater improvement in the Oxford score and Knee Society Score in patients who received a cemented baseplate compared to tantalum and the pegged porous groups. However, radiological and survival outcomes were similar in all three groups. Overall survivorship was 99.6%, with one knee with cementless tibial fixation and screws revised for subsidence at 3 years. There were no cases of venous thromboembolism, periprosthetic fracture or infection.

Conclusions

Irrespective of tibial fixation method, functional and radiological outcomes remain similar at follow-up at 10 years, with no clear difference in outcome between each group. Each method of fixation also had excellent survivorship over this period and should reassure surgeons that whichever method of fixation they choose, long-term outcomes are likely to be satisfactory.

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Data availability

All data used in this study was included in the manuscript.

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Funding

The authors did not receive support or funding from any organization for the submitted work.

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Authors and Affiliations

  1. Sydney Orthopaedic Research Institute, Sydney, Australia

    George E. H. Awwad, H. Ahedi, D. Angadi, V. Kandhari & M. R. J. Coolican

  2. Flinders Medical Centre, Adelaide, Australia

    George E. H. Awwad

  3. University of Tasmania, Tasmania, Australia

    H. Ahedi

  4. Royal Northshore Hospital, Sydney, Australia

    M. R. J. Coolican

Authors
  1. George E. H. Awwad
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  2. H. Ahedi
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  3. D. Angadi
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  4. V. Kandhari
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  5. M. R. J. Coolican
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Correspondence to George E. H. Awwad.

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The authors have no relevant financial or non-financial conflicts of interests to disclose.

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The authors obtained ethics approval for this study from the Northern Sydney Local Health District Human Research Ethics Committee, and written informed consent was obtained from all the participants.

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Awwad, G.E.H., Ahedi, H., Angadi, D. et al. A prospective randomised controlled trial of cemented and uncemented tibial baseplates: functional and radiological outcomes. Arch Orthop Trauma Surg 143, 5891–5899 (2023). https://doi.org/10.1007/s00402-023-04831-z

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  • DOI: https://doi.org/10.1007/s00402-023-04831-z

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