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    TECH SHOWCASE: Cementless Fixation in Total Knee Arthroplasty

    Editor’s Note: A session at ICJR’s 13th Annual Winter Hip & Knee Course was billed as a Technology Showcase, featuring 8 presentations on aspects of technology and techniques intended to help surgeons improve outcomes of hip and knee arthroplasty. We are highlighting those presentations on ICJR.net this week.

    H. Del Schutte Jr., MD, has long been a proponent of cementless fixation in total knee arthroplasty (TKA), starting with revision procedures more than 15 years ago. He told attendees at ICJR’s 13th Annual Winter Hip & Knee Course that his interest in cementless fixation has not waned over time, but has, in fact, only increased to that point that it is his go-to for primary TKAs as well.

    Registry data from the US show that more and more surgeons are thinking like Dr. Schutte: The 2020 Annual Report from the American Joint Replacement Registry indicates that the percentage of cementless TKAs has risen from just 1.9% of primary procedures in 2012 to 9.9% in 2019. [1]

    There are good reasons to avoid using cement, Dr. Schutte said, beginning with TKA failure. Worldwide registry data show that aseptic loosening is a top reason for revision TKA, typically right behind infection. [1,2] Similarly, studies are showing good short- to long-term survivorship for cementless TKA, particularly with today’s improved materials and implants. [3-7]

    Dr. Schutte noted other benefits of cementless fixation, including:

    • It’s efficient, saving money and time in the OR.
    • It’s compatible with tourniquetless technique.
    • It can be used effectively with high-demand patients, including those who are morbidly obese. [8]
    • It can also be used effectively with patients who have poor bone quality.

    Click the image above to watch Dr. Schutte’s presentation and hear more about cementless fixation in TKA.

    Faculty Bio

    H. Del Schutte Jr., MD, is Chief of Surgery at East Cooper Medical Center, Mount Pleasant, South Carolina, and the Medical Director of the hospital’s Comprehensive Joint Program. He is the founder and Director of the Charleston Institute of Advanced Orthopedics. He specializes in adult hip and knee reconstruction.

    Disclosures: Dr. Schutte has disclosed that he is a paid consultant for Medtronic.

    References

    1. American Joint Replacement Registry (AJRR): 2020 Annual Report. Rosemont, IL: American Academy of Orthopaedic Surgeons (AAOS), 2020. 
    2. Tathis DT, Hirschmann MT. Why do knees after total knee arthroplasty fail in different parts of the world? J Orthop. 2020 Dec 31;23:52-59. doi: 10.1016/j.jor.2020.12.007. eCollection Jan-Feb 2021.
    3. Dalury DF. Cementless total knee arthroplasty: current concepts review. Bone Joint J. 2016 Jul;98-B(7):867-73. doi: 10.1302/0301-620X.98B7.37367.
    4. Ritter MA, Meneghini RM. Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty. J Arthroplasty. 2010 Jun;25(4):507-13. doi: 10.1016/j.arth.2009.04.018. Epub 2009 May 8.
    5. Nam D, Lawrie CM, Salih R, Nahhas CR, Barrack RL, Nunley RM. Cemented versus cementless total knee arthroplasty of the same modern design: a prospective, randomized trial. J Bone Joint Surg Am. 2019 Jul 3;101(13):1185-1192. doi: 10.2106/JBJS.18.01162.
    6. Mont MA, Pivec R, Issa K, Kapadia BH, Maheshwari A, Harwin SF. Long-term implant survivorship of cementless total knee arthroplasty: a systematic review of the literature and meta-analysis. J Knee Surg. 2014 Oct;27(5):369-76. doi: 10.1055/s-0033-1361952. Epub 2013 Dec 7.
    7. Harwin SF, Kester MA, Malkani AL, Manley MT. Excellent fixation achieved with cementless posteriorly stabilized total knee arthroplasty. J Arthroplasty. 2013 Jan;28(1):7-13. doi: 10.1016/j.arth.2012.06.006. Epub 2012 Jul 31.
    8. Sinicrope BJ, Feher AW, Bhimani SJ, et al. Increased survivorship of cementless versus cemented TKA in the morbidly obese. A minimum 5-year follow-up. J Arthroplasty. 2019 Feb;34(2):309-314. doi: 10.1016/j.arth.2018.10.016. Epub 2018 Oct 17.