Results of cementless total knee arthroplasty in an older rheumatoid arthritis population. Survival analysis of cemented Press-Fit Condylar total knee arthroplasty. Comparison of screw and screwless fixation in cementless total knee arthroplasty. Five-year results of the Sigma total knee arthroplasty. To Cement or Not? Two-Year Results of a Prospective, Randomized Study Comparing Cemented Vs. Cementless Total Knee Arthroplasty (TKA). The effect of Palamed® G bone cement on early migration of tibial components in total knee arthroplasty Minimally Invasive Computer-Assisted Total Knee Arthroplasty Compared With Conventional Total Knee Arthroplasty: A Prospective 9-Year Follow-Up. Navigated Cementless Total Knee Arthroplasty - Medium-Term Clinical and Radiological Results§ Fixed-bearing versus mobile-bearing total knee arthroplasty: a prospective randomised, clinical and radiological study with mid-term results at 7 years. Clinical outcome using a ligament referencing technique in CAS versus conventional technique Problems With Cementless Total Knee Arthroplasty at 11 Years Followup Short-Term Outcome after Computer-Assisted versus Conventional Total Knee Arthroplasty: A Randomised Controlled Trial Excellent fixation achieved with cementless posteriorly stabilized total knee arthroplasty. Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. Uncemented HA-coated Implant is the Optimum Fixation for TKA in the Young Patient To use or not to use continuous passive motion post-total knee arthroplasty presenting functional assessment results in early recovery. Knee Arthroplasty in the Young Patient: Survival in a Community Registry
Fifty-five total knee arthroplasties ( TKAs ) in thirty-nine adult ( mean age , 62 years ) patients with rheumatoid arthritis were studied prospect ively for a period of 1 - 7 years . All of the procedures were performed using cementless fixation of the tibial and femoral components . The Knee Society clinical rating system mean knee scores increased 56 points after operation ( mean , 88 points ) , and the mean functional scores increased 28 points ( mean , 64 points ) . Two revisions ( 4 % ) have been required , one for secondary late infection and one for failure of a cementless metal-backed patellar component . Good bone stock was retained in both , allowing for uneventful cementless revision . Forty-two arthroplasties ( 76 % ) were completely pain-free , twelve ( 22 % ) had mild , occasional discomfort with weight-bearing , and one ( 2 % ) had moderate pain at last examination . In this older rheumatoid population , cementless TKA offers good or excellent early clinical results and excellent preservation of bone stock should revision become necessary We performed a survival analysis on 354 cemented primary Press-Fit Condylar ( PFC ) total knee arthroplasties ( TKA ) in 277 patients with prospect i ve follow-up ( mean , 6 years ; range , 2 - 11.7 years ) . No patient was lost to follow-up . Using revision for all causes as the endpoint , the cumulative survival rate at 10 years was 95.5 % ( 95 % confidence interval , 90.1%-98.1 % ) . The 10-year clinical outcome available on 41 patients was good , with significant improvement in pain and mobility assessment s using the Nottingham data collection system . Our results indicate that the cemented PFC TKA has good long-term survival based on revision as the endpoint . Revision for implant failure is rare and brings to question modifications to this prosthesis This study compared two groups of consecutive patients undergoing total knee arthroplasty ( TKA ) with an identical cementless tibial baseplate supplementally fixated with and without screws . In 58 TKAs , two 6.5-mm cancellous screws were used for fixation , and in 58 TKAs , screwless fixation was used . Clinical evaluation was performed using the Hospital for Special Surgery knee score , and fluoroscopically guided radiographs were evaluated for radiolucencies . In the screw fixation group , average follow-up was 82+/-6 months ( range , 59 - 89 months ) and average patient age at surgery was 63 years . For the screwless fixation group , average follow-up was 67+/-5 months ( range , 48 - 76 months ) and average patient age at surgery was 62 years .  Average knee score was 97 for the screw fixation group and 98 for the screwless fixation group . This study demonstrated stability in cementless TKA both with and without screw fixation in the mid-term using the Natural-Knee II tibial component The DePuy Sigma total knee arthroplasty ( TKA ) was introduced in 1997 as a modification of the Press Fit Condylar Knee ( PFC ) TKA and has been used extensively in the United Kingdom and worldwide . It is the most commonly used TKA in Engl and and Wales , where it accounts for 36 % of all primary TKA . The PFC was well established , with reported 10-year survival rates of 93 - 97 % , but this study reports the first 5-year clinical and radiographic follow-up data for the Sigma TKA . Over a 10-month period , 212 Sigma TKAs were performed in 180 patients . Patients were seen at a specialist nurse-led clinic 7 to 10 days before admission and at 6 months , 18 months , 3 years and 5 years after surgery . Data were recorded prospect ively at each visit . Radiographs were obtained at the 5-year follow-up appointment . Of 212 knees , 178 ( 151 patients ) were alive at 5 years . Three were lost to follow up . Six knees ( 3.0 % ) were revised , five for infection and one underwent change of polyethylene insert at 4.9 years . Five-year survival with an endpoint of revision for any reason was 97.0 % ; with an endpoint of revision for aseptic failure it was 99.5 % . The median American Knee Society knee rating score was 93 out of 100 at 5 years compared with 25 out of 100 at admission . Of 147 radiographs , none showed radiographic loosening of either component . Seventeen ( 11.6 % ) showed radiolucent lines . Twenty-eight ( 19.0 % ) had alignment outside the range of 7+/-3 degrees valgus . These results suggest that the Sigma TKA gives acceptable clinical results after 5 years . Further follow-up studies are required to see if this performance is maintained in the long term The optimal mode of fixation in total knee arthroplasty ( TKA ) is a subject of debate . We enrolled 100 TKA patients r and omized to cemented or cementless fixation .  Knee Society Scores ( KSS ) , Oxford scores and pain visual analog scales ( VAS ) were collected pre-operatively and post-operatively . Two-year follow-up was obtained for 93 patients . The mean VAS trended higher for the cementless group at 4 months ( P=0.06 ) . At 2 years , the KSS functional scores , Oxford scores , and self-reported questions for satisfaction , less pain and better function were similar but the cemented group had higher KSS clinical scores ( 96.4 vs. 92.3 , P=0.03 ) . More radiolucencies were seen in cementless knees ( P<0.001 ) . The cementless group had one revision for instability and one cemented knee was revised for infection .  Cementless TKA showed equivalent survivorship ( revision for any reason as the endpoint ) compared to cemented TKA at this early follow-up . Close monitoring of radiolucencies is important with continued follow-up Abstract Objective : Migration of the tibial component in total knee arthroplasty ( TKA ) is subject of many studies using roentgen stereophotogrammetric analysis ( RSA ) . In previous studies of cemented and uncemented tibial components , high migration values were found . Improvements in cementing technique , prosthetic design and pre-coating techniques reduced these values as shown in more recent studies . Material and subjects : A total of 35 patients were initially included in the study and operated on between 12/1999 and 10/2000 . All patients received a NexGen ® TKA cemented into the proximal tibia using Palamed ® G bone cement . The implants and the tibial metaphysis were marked with st and ard tantalum markers . Radiostereometric analysis was performed post-operatively and after 3 , 6 and 12 months using a st and ard digital radiostereometric analysis . Functional parameters were assessed using the Knee Society Score ( KSS ) clinical rating system . Results : There were no complications and failures within the first year . After 1 year radiostereometric measurements of the translational parameters along and the rotational parameters around the x- , y- and z-axis revealed : X-Trans –0.19 mm , Y-Trans + 0.02 mm , Z-Trans + 0.08 mm , X-Rot + 0.26 ° , Y-Rot –0.35 ° , Z-Rot + 0.09 ° . The maximum total point motion was + 0.96 mm and the mean maximum subsidence was –0.23 mm . Except for anterior-posterior , medio-lateral stability and extension leg all endpoints of the KSS clinical rating system showed a significant improvement . Conclusions : After 12 months , the use of Palamed ® G bone cement in total knee arthroplasty was demonstrated to be safe . Both the clinical and radiostereometric results were good and comparable to the results reported in other RSA studies in cemented total knee arthroplasty BACKGROUND Studies on minimally invasive computer-assisted total knee arthroplasty ( MICA-TKA ) have shown promising results , but are limited by short follow-up . The purpose of this study was to compare the midterm radiographic features and functional outcomes between patients who underwent MICA-TKA and conventional TKA .  METHODS A total of 108 patients who were r and omized to undergo MICA-TKA or conventional TKA during 2004 and 2005 were contacted for a prospect i ve follow-up review . Patients who were lost to contact , have passed away , or declined to participate in the study were excluded . Objective functional measurements and radiographs were obtained for assessment . RESULTS By the time of this study , 2 patients from the conventional group had undergone revision TKA , one due to infection and one due to aseptic loosening . A total of 67 patients ( 62.04 % ) were followed up for an average period of 9.07 years ( 8.51 - 9.61 years ) . At follow-up , functional scores were comparable between the 2 groups . No significant intergroup differences were found in mechanical knee alignment and component placement angle in the coronal views . No statistical or clinical significance were noticed in radiographic signs of component loosening . CONCLUSIONS MICA-TKA provided similar clinical , functional , and radiographic outcomes compared with conventional TKA after an average of 9-year follow-up . This technique can be used to exploit its short-term advantages without compromising midterm outcomes Purpose : The objective of this prospect i ve study was to evaluate the medium-term clinical and radiological results after navigated cementless implantation , without patella resurfacing , of a total knee endoprosthesis with tibial and femoral press-fit components , with a focus on survival rate and clinical outcome . The innovation is the non-cemented fixation together with the use of a navigation system . Scope and Methods : Sixty patients with gonarthrosis were included consecutively in this study . In all cases , the cementless Columbus total knee endoprosthesis with a coating out of pure titanium was implanted , using a navigation system . The Knee Society Score showed a statistically significant increase from 75 ( ± 21.26 ) before surgery to 180 ( ± 16.15 ) after a mean follow-up of 5.6 ( ± 0.25 ) years . The last radiological examination revealed no osteolysis . No radiolucent lines were seen at any time in the area of the femoral prosthetic components . In the tibial area , radiolucent lines were seen in 24.4 % of the cases , mostly in the distal uncoated part of the stem . During follow-up , no prosthesis had to be replaced because of aseptic loosening while in 2 cases revision surgery was necessary due to septic loosening and in 1 case due to unexplainable pain . Results and Conclusions : Navigated cementless implantation of the Columbus total knee endoprosthesis yielded good clinical and radiological results in the medium term . The excellent radiological osteointegration of the prosthetic components , coated with a microporous pure titanium layer and implanted with a press-fit technique , should be emphasized Mobile-bearing ( MB ) total knee arthroplasty ( TKA ) was developed as an alternative to the established fixed-bearing ( FB ) design because of theoretical advantages . Short-term studies comparing these design s have not shown any differences in clinical and radiographic results . We compared the results at 7 years of a r and omised study of patients undergoing TKA using either a FB or a MB variant of the same prosthesis . Fifty-two patients ( 52 knees ) with an average age of 70 years received a FB posterior-stabilized prosthesis , and 50 patients ( 52 knees ) with an average age of 72 years , a MB prosthesis .  All implants were cemented and the patella was routinely resurfaced . Preoperatively , there were no differences between the two groups , and surgical procedure and postoperative protocol were the same for both . At an average follow-up of 7.1 years , no significant differences of FB over MB design could be demonstrated with respect to the American Knee Society score ( AKSS ) , pain score , a question naire of general health ( SF-12 score ) , range of motion ( ROM ) , or complication rates . Radiographs showed no significant difference in prosthetic alignment or evidence of loosening . Two knees with a MB design required reoperation , one for persistent joint stiffness and another to treat septic loosening . One patient with a MB prosthesis with signs of tibial component loosening was asymptomatic . We conclude that at mid-term follow-up there is no evidence to prove the superiority of MB over FB TKA with regard to the clinical and radiographic results Purpose Computer-assisted surgery ( CAS ) for total knee arthroplasty ( TKA ) has become increasingly common over the last decade . There are several reports including meta-analyses that show improved alignment , but the clinical results do not differ . Most of these studies have used a bone referencing technique to size and position the prosthesis . The question arises whether CAS has a more pronounced effect on strict ligamentous referencing TKAs . Methods We performed a prospect i ve cohort study comparing clinical outcome of navigated TKA ( 43 patients ) with that of conventional TKA ( 122 patients ) . Patients were assessed preoperatively , and 2 and 12 months postoperatively by an independent study nurse using vali date d patient-reported outcome tools as well as clinical examination . Results At 2 months , there was no difference between the two groups . However , after 12 months , CAS was associated with significantly less pain and stiffness , both at rest and during activities of daily living , as well as greater overall patient satisfaction . Conclusion The present study demonstrated that computer-navigated TKA significantly improves patient outcome scores such as WOMAC score ( P = 0.002 ) and Knee Society score ( P = 0.040 ) 1 year after surgery in using a ligament referencing technique . Furthermore , 91 % were extremely or very satisfied in the CAS TKA group versus 70 % after conventional TKA ( P = 0.007 ) One hundred two patients with 131 consecutive cementless total knee arthroplasties that retained the posterior cruciate ligament were followed up prospect ively . The average age of the patients was 58 years ( range , 32–75 years ) . The mean followup on the surviving knee arthroplasties was 11 years ( range , 7–16 years ) . The patellar component was metal-backed in the first 112 ( 85 % ) knees , cementless all-polyethylene in the last 17 ( 13 % ) knees , and two knees had a prior patellectomy . Forty-four metal-backed patellar components ( 48 % ) were revised ; nine were loose , and 35 had polyethylene wear through . Thirteen femoral components ( 12 % ) were revised because of femoral abrasion from a failed metal-backed patellar component . No other femoral component was revised , loose , or had osteolysis develop . Nine ( 8 % ) tibial components had failure of ingrowth ; eight have been revised . Partial radiolucencies occurred in 53 % of the tibias . Thirteen ( 12 % ) small osteolytic lesions developed , all around screws or screw holes in the tibial components . At an average of 11 years followup , cementless fixation yielded mixed results : cementless femoral fixation was excellent and metal-backed patellar components had a 48 % patellar revision rate . Cementless tibial components had an 8 % aseptic loosening rate and a 12 % incidence of small osteolytic lesions . Based on these results , the authors have ab and oned cementless fixation in total knee arthroplasty Purpose . To compare the short-term functional outcome after computer-assisted total knee arthroplasty ( TKA )  versus conventional TKA . Methods . 23 men and 67 women aged 48 to 80 years were r and omised to undergo ( 1 ) conventional TKA using an intramedullary guide , ( 2 ) conventional TKA using an extramedullary guide , or ( 3 ) computer-assisted TKA . Two senior surgeons performed all the TKAs using the same TKA system and the st and ard anteromedial arthrotomy with eversion of the patella . Patients were assessed by physiotherapists before and 6 months and 2 years after TKA using the Short Form-36 Health Survey , Oxford Knee Score , and Knee Society Score . Results . Of the 90 patients , 67 and 70 were assessed at 6 months and 2 years after TKA , respectively . No patient developed deep infection or required revision surgery . Functional outcomes of the 3 groups did not differ significantly at the corresponding follow-ups . Conclusion . Significant improvement in the functional outcome was not shown in patients treated with  computer-assisted TKA  , compared with conventional TKA . Thus , computer-assisted TKA has limited additional short-term benefits . Further studies with longer follow-up are required to examine the benefits of computer-assisted TKA Cementless posteriorly stabilized ( PS ) total knee arthroplasty has not been widely accepted primarily because of prior unpredictable results and concern about micromotion at the tibial fixation interface caused by the cam/post interaction . A prospect i ve consecutive series of 114 cementless , tricompartmental periapatite-coated single-radius PS implants in 110 patients with a mean age 62 years was performed to determine if initial stability and biologic fixation could be achieved . At a mean follow-up of 36 months , all implants demonstrated radiographic evidence of stable biologic fixation with no evidence of loosening , osteolysis , stress shielding , or progressive radiolucent lines . Based on these early results , cementless , periapatite-coated single-radius PS total knee arthroplasty offers marked promise Robot-assisted Total Knee Arthroplasty ( TKA ) improves the accuracy and precision of component implantation and mechanical axis ( MA ) alignment . Joint-line restoration in robot-assisted TKA is not widely described and joint-line deviation of>5 mm results in mid-flexion instability and poor outcomes . We prospect ively r and omised 60 patients into two groups : 31 patients ( robot-assisted ) , 29 patients ( conventional ) .  No MA outliers ( > ±3 ° from neutral ) or notching was noted in the robot-assisted group as compared with 19.4 % ( P=0.049 ) and 10.3 % ( P=0.238 ) respectively in the conventional group . The robot-assisted group had 3.23 % joint-line outliers ( > 5 mm ) as compared to 20.6 % in the conventional group ( P=0.049 ) . Robot-assisted TKA produces similar short-term clinical outcomes when compared to conventional methods with reduction of MA alignment and joint-line deviation outliers Fixation of the tibial component in total knee arthroplasty in younger patients remains controversial . We evaluate the results of three different types of fixation of the Profix total knee arthroplasty  in a r and omized controlled trial of 97 consecutive knees ( 85 patients ) with osteoarthrosis or inflammatory arthritis with 2-year followup of all patients . We r and omized patients to three different types of fixation of the tibial component : cemented , uncemented ( HA coated ) with screws , or uncemented ( HA coated ) without screws . We performed clinical evaluations and radiostereometric analysis at 6 weeks , and 3 , 6 , 12 and 24 months postoperatively . The knees in the uncemented groups migrated more than those in the cemented group during the first 3 months , but at 2 years we observed no differences . The uncemented implants  displayed all migration within the first 3 months . The cemented implants did not stabilize but had continuously increasing migration during the followup . Cementless implants without screws  did not migrate more than implants with screws and displayed similar pattern of migration , indicating screws do not improve fixation .  Uncemented fixation using hydroxyapatite-coated implants without screws seems to be the best solution for the younger patient . Level of Evidence : Therapeutic Level I. See the Guidelines for Authors for a complete description of levels of evidence Continuous passive motion ( CPM ) , though of doubtful value , is yet routinely practice d post-total knee arthroplasty ( TKA ) . We prospect ively distributed 84 patients with TKA to 1 of the 3 st and ard rehabilitation regimes : no-CPM , 1-day-CPM , and 3-day-CPM .  We recorded a unique " Timed up and go " test besides pain , Western Ontario and McMaster Universities ( WOMAC ) , short form-12 ( SF-12 ) , range of motion , knee and calf swelling , and wound healing parameters . Our st and ardized and elaborate measurements preoperatively and on postoperative days 3 , 5 , 14 , 42 , and 90 showed no statistically significant difference among the 3 groups in each parameter . We concluded that CPM gives no benefit in immediate functional recovery post-TKA , and in fact , the postoperative knee swelling persisted longer . We have since then discontinued its use in our patients without any untoward effect Operative options for the younger patient with an arthritic knee remain controversial . We prospect ively followed 1047 patients 55 years old or younger who underwent knee arthroplasty in a community joint registry over a 14-year period . Patients were implanted with 1047 joints of three predominant design s by 48 surgeons in four hospitals associated with a community joint registry . The mean age for this cohort was 49.8 years , and 62.8 % ( 657/1047 ) of the patients were female . There were a total of 73 revisions performed , 5.6 % ( 37/653 ) in women and 9.2 % ( 36/394 ) in men . Cemented TKAs performed best , with a cumulative revision rate of 15.5 % , compared to 32.3 % in unicompartmental knee arthroplasty ( UKA ) patients and 34.1 % in cementless design s. Men had a higher cumulative revision rate than women , 31.9 % compared to 20.6 % . Adjusting for implant type and gender , there was no difference in cumulative revision rate based on diagnosis ( OA versus other ) or age group ( ≤40 , 41 - 45 , 46 - 50 , 51 - 55 years ) or between cruciate-retaining and -substituting design s. Eighty five percent of cemented TKA implants survived at 14 years in the population under 55 years of age in this community registry . Cementless design s and UKA increased revision risk independently . Level of Evidence : Level II , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence
Implant survivorship for cementless TKA was comparable to the current gold st and ard cemented TKAs
Cementless  total knee arthroplasty ( TKA )  has had limited use in the United States , however , recent reports have demonstrated promising results , but there has been no meta- analysis to examine these outcomes in the past 5 years .