Cemented vs uncemented total knee arthroplasty shows no significant difference in 5-year survivorship according to a large cohort study. This finding challenges long-held assumptions about fixation methods in knee replacement surgery and provides valuable insights for surgeons and patients.
This article summarizes the findings from a comprehensive study titled "No difference in 5-year survivorship between cemented versus cementless total knee arthroplasty in a cohort of 5266 patients using a deep-dish mobile bearing implant" published in Knee Surgery, Sports Traumatology, Arthroscopy in 2025, led by Professor Etienne Cavaignac and his team at Toulouse University Hospital.
For a deeper understanding of knee surgery techniques and outcomes, we encourage you to explore Professor Cavaignac's extensive portfolio of research publications, which spans from ACL reconstruction to innovative approaches in knee arthroplasty and sports medicine.
The ongoing debate surrounding cemented and cementless total knee arthroplasty has been a major topic of discussion among orthopedic surgeons for decades. Historically, cemented fixation has been considered the gold standard, but advances in implant technology have sparked renewed interest in cementless alternatives.
The study led by Professor Cavaignac addresses this debate by examining a significant cohort of patients who received the same implant design with different fixation methods. With 4,549 patients receiving cementless implants and 717 receiving cemented ones, the research provides substantial evidence for comparing these approaches.
Concerns about implant loosening without infection in cemented fixations have sparked interest in biological fixation methods. This approach uses osseointegration (where bone grows directly onto the implant surface) a technique first successful in hip replacements.
Today's cementless knee implants use advanced coatings such as plasma-sprayed titanium and hydroxyapatite that help the bone attach to the implant, showing promising results for long-term stability.
The study revealed that cemented total knee arthroplasty demonstrated a 5-year survival rate of 97.6%, which was statistically comparable to the 98.7% survival rate observed in cementless implants. This challenges the perception that one fixation method might be superior to the other in the mid-term follow-up period.
When examining revision causes, both groups showed similar patterns. Infection was the primary reason for revision in both cemented (44.4%) and cementless (46.9%) groups, followed by aseptic loosening. Interestingly, while loosening was more common in the cemented group (33.3% vs 14.3%), pain was a more frequent revision cause in the cementless group.
The functional outcomes measured by the International Knee Score (IKS) showed no significant differences between the two groups at the 5-year mark. Cemented implants achieved a score of 175 compared to 182 for cementless implants, with improvements of 75 and 84 points respectively from preoperative scores.
For fully cemented total knee arthroplasty, the study suggests that concerns about increased revision rates compared to cementless alternatives may be unfounded, at least in the mid-term period examined.
No-cement technique in total knee arthroplasty showed slight advantages in certain measurements, though most were not statistically significant. One notable finding was that patients with cementless implants demonstrated slightly better knee flexion (118.5° versus 112.7°), which might contribute to improved functionality in daily activities.
The cementless total knee arthroplasty review section of the study indicates that these implants might offer benefits for younger, more active patients who may benefit from the biological fixation and potential for bone preservation. The osseointegration provided by modern coatings offers theoretical advantages for long-term stability.
The cementless total knee arthroplasty current concepts review suggests that advances in implant materials and designs have addressed many of the concerns that led to failures in earlier generations of cementless implants. The plasma-sprayed titanium and hydroxyapatite coating used in the study's implants represent the cutting edge of this technology.
The study provides valuable evidence that this approach offers comparable safety and efficacy to traditional cemented techniques. This may help surgeons make more informed decisions based on patient characteristics rather than assumptions about superiority of one technique.
For surgeons deciding between cemented or cementless total knee arthroplasty, this research provides evidence that both approaches can deliver excellent mid-term results when using high-quality implants with proper surgical technique.
The comparison of cemented and uncemented fixation in total knee arthroplasty revealed no significant differences in surgery-free survival rates at 5 years (95.8% for cementless vs 95.5% for cemented). When excluding infections, the survival rates were 96.9% and 97.5% respectively, again showing no statistical difference.
The decision should therefore consider other factors such as patient age, bone quality, activity level and surgeon experience rather than assuming inherent superiority of either fixation method.
If you are experiencing knee pain or have been recommended for knee replacement surgery, consider consulting with Professor Etienne Cavaignac, whose evidence-based approach and extensive experience in both cemented and cementless techniques ensure you receive the most appropriate treatment for your specific condition.
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