Functional outcomes comparative analysis of cemented and uncemented total knee arthroplasty

Comparison of postoperative blood loss in cementless and cemented total knee arthroplasty: a systematic review

INTRODUCTION

With the advancement of porous surface processing technology, cementless total knee arthroplasty (TKA) has once again garnered attention. Cementless TKA lacks cement sealing, raising concerns regarding potential blood loss. Recently, patient blood management (PBM) protocols have been introduced to mitigate postoperative blood loss and transfusions. In this systematic review, we aimed to address whether cementless TKA leads to increased blood loss and transfusion rates as compared with cemented TKA. Additionally, we explored the impact of contemporary PBM protocols on post-TKA hemodynamics.

METHODS

This systematic review included prospective randomized trials and retrospective studies that compared blood loss and PBM between cementless and cemented TKA. A comprehensive literature search for publications from 1980 onwards was conducted using databases such as PubMed, MEDLINE, and EMBASE. Furthermore, we conducted a thorough examination of the bibliographies of all relevant articles that were retrieved. Studies that met our inclusion criteria were assessed carefully for pertinent data. This systematic review followed the Preferred Reporting Items for Systematic Re-views and Meta-Analyses (PRISMA) statement and was registered in the PROSPERO register (CRD42024507236).

RESULTS

A total of twelve studies were included in this study. Among these, six papers reported lower blood loss in cemented TKA, while the other six papers found no significant difference in perioperative blood loss between the two groups. From the perspective of PBM, seven studies applied PBM protocols including systematic and topical tranexamic acid, autogenous transfusion, strict transfusion threshold and drain clamping, while the remaining five studies did not. If PBM protocols were implemented, no significant difference in blood loss was observed based on the implant fixation method.

CONCLUSION

In the context of recent studies implementing PBM protocols, the choice of implant fixation method appears to have no relevant impact on post-TKA blood loss. Nevertheless, it is important to note that the reporting of outcomes and PBM protocols exhibit considerable variation and heterogeneity.

Short-Term (6 Months or Less) Pain in Cemented versus Cementless Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Cementless total knee arthroplasty (TKA) has increased in popularity to potentially improve survivorship. Radiostereometric studies demonstrate increased component migration during the first 3 to 6 months in cementless constructs, generating concern for increased postoperative pain during early osseointegration. The purpose of this study was to evaluate short-term (≤ 6 months) pain and function in cemented versus cementless TKA. We hypothesized that cementless TKA patients report increased pain during the short-term (≤ 6 months) postoperative period.

METHODS

The MEDLINE, EMBASE, CINAHL, and Cochrane Libraries were searched for studies evaluating short-term (≤ 6 months) outcomes of cemented versus cementless primary TKA. Studies involving hybrid fixation were excluded. A meta-analysis was performed using standardized mean difference for primary outcomes (early postoperative pain) and weighted mean difference (WMD) for secondary outcomes (early postoperative function).

RESULTS

There were eleven studies included. There was no significant difference in acute postoperative pain between cemented and cementless TKA within 6 months of index TKA (standardized mean difference 0.08 in favor of cemented TKA; P = .10). Early postoperative forgotten joint scores (WMD 0.81; P = .81) and knee injury and osteoarthritis outcome scores for joint replacement (WMD 0.80 in favor of cemented TKA; P = .14) were also similar between groups.

CONCLUSIONS

There is no difference in short-term (≤ 6 months) pain or early function between patients receiving cemented and cementless TKA. This suggests that surgeons may utilize cementless TKA without fear of increased pain due to micromotion within 6 months of index arthroplasty. However, additional studies with uniform assessment methods are needed to further inform differences in short-term pain and early functional outcomes between cemented and cementless TKA.

Cementless Total Knee Arthroplasty: A State-of-the-Art Review

» The demographic profile of candidates for total knee arthroplasty (TKA) is shifting toward younger and more active individuals.» While cemented fixation remains the gold standard in TKA, the interest is growing in exploring cementless fixation as a potentially more durable alternative.» Advances in manufacturing technologies are enhancing the prospects for superior long-term biological fixation.» Current research indicates that intermediate to long-term outcomes of modern cementless TKA designs are comparable with traditional cemented designs.» The selection of appropriate patients is critical to the success of cementless fixation techniques in TKA.» There is a need for high-quality research to better understand the potential differences and relative benefits of cemented vs. cementless TKA systems.

No Blood Loss Increase in Cementless vs. Cemented Fixation Following Bilateral Total Knee Arthroplasty: A Propensity Score Matching Study

Background and Objectives: Recent advancements in three-dimensional printing technology have enhanced the biologic fixation of cementless total knee arthroplasty (TKA), therefore increasing the utilization of newer-generation cementless implants. However, the lack of sealing and tamponade effect of cement on the resected bone surface after cementless TKA raises concerns regarding the potential for greater blood loss compared to cemented TKA. The aim of this study was to (1) compare blood loss and transfusion rates between cementless and cemented TKAs and (2) identify the risk factor for higher blood loss in patients who underwent 1-week-interval staggered bilateral (SB) TKA. Materials and Methods: This retrospective, propensity-matched study included 54 cementless and 53 cemented SB TKAs performed by a single surgeon from 2019 to 2023 with a single implant that has similar design features in both cementless and cemented implants. All patients underwent 1-week-interval SB TKA and received the same patient blood management (PBM) and rehabilitation protocol. The estimated total blood loss (TBL), transfusion rate, and total hemoglobin drop were assessed. Patients were categorized according to TBL into average TBL and higher TBL groups. Univariate and multiple logistic regression analyses were performed to identify risk factors for higher blood loss. Results: There was no difference in TBL between cementless and cemented TKA groups (1233 ± 299 and 1282 ± 309 mL, respectively; p > 0.05). In addition, no between-group differences in the transfusion rate and mean total hemoglobin drop were observed. The logistic regression analyses revealed that whether TKA was cementless or cemented was not associated with higher blood loss; rather, the only identified risk factor was the pre-TKA patient blood volume (odd ratio 1.001, 95% confidence interval 1.000-1002, p = 0.026). Conclusions: Contemporary cementless fixation does not increase blood loss or transfusion rates compared to cemented fixation in patients undergoing 1-week-interval staggered bilateral TKA.