Cementless unicompartmental knee replacement achieves better ten year clinical outcomes than Cemented: A systematic review

Hasan R Mohammad*, Garrett Bullock, James Kennedy, Stephen Mellon, David W Murray, Andrew Judge

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Purpose: The aim of this study was to report and compare the long term revision rate, revision indications and patient reported outcome measures of cemented and cementless Unicompartmental knee replacements (UKR).
Methods: Databases Medline, Embase and Cochrane Central of Controlled Trials were searched to identify all UKR studies reporting the ≥10 year clinical outcomes. Revision rates per 100 component years (% per annum (%pa)) were calculated by fixation type and then subgroup analysis for fixed and mobile bearing UKRs was performed. Mechanisms of failure and patient reported outcome measures are reported.
Results: 25 studies were eligible for inclusion (n=10,736), of which there were 8790 cemented and 1946 cementless UKRs. The revision rate was 0.73%pa (CI 0.66-0.80) and 0.45%pa (CI 0.34-0.58) per 100 component years respectively with the cementless having a significantly (p<0.001) lower overall revision rate. Therefore, based on these studies, the expected 10 year survival of cementless UKR would be 95.5% and cemented 92.7%. Subgroup analysis revealed this difference remained significant for the Oxford UKR (0.37%pa vs 0.77%pa, p<0.001), but for non-Oxford UKRs, there were no significant differences in revision rates of cemented and cementless UKRs (0.57%pa vs 0.69% pa, p=0.41). Mobile bearing UKRs had significantly lower revision rates than fixed bearing UKRs in cementless (p=0.001), but not cemented groups (p=0.13). Overall the revision rates for aseptic loosening and disease progression were significantly lower (p=0.02 and p=0.009 respectively) in the cementless group compared to the cemented group (0.06 vs 0.13%pa and 0.10 vs 0.21%pa respectively).
Conclusions: Cementless fixation had reduced long term revision rates compared to cemented for the Oxford UKR. For the non-Oxford UKRs the revision rates of cementless and cemented fixation types were equivalent. Therefore cementless UKRs offer at least equivalent if not lower revision rates compared to cemented UKRs.
Original languageEnglish
Number of pages17
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume(2020)
DOIs
Publication statusPublished - 1 Jul 2020

Keywords

  • arthroplasty
  • UKA
  • unicondylar

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