Cemented vs. cementless fixation in primary total knee arthroplasty: a systematic review and meta-analysis

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Abstract

Over 100,000 total knee replacements (TKRs) are carried out in the UK annually, with cemented fixation accounting for approximately 95% of all primary TKRs. In Australia, 68.1% of all primary TKRs use cemented fixation, and only 10.9% use cementless fixation. However, there has been a renewed interest in cementless fixation as a result of improvements in implant design and manufacturing technology.
This meta-analysis aimed to compare the outcomes of cemented and cementless fixation in primary TKR. Outcome measures included the revision rate and patient-reported functional scores.
MEDLINE and EMBASE were searched from the earliest available date to November 2018 for randomized controlled trials of primary TKAs comparing cemented versus cementless fixation outcomes.
Six studies met our inclusion criteria and were analysed. A total of 755 knees were included; 356 knees underwent cemented fixation, 399 underwent cementless fixation. They were followed up for an average of 8.4 years (range: 2.0 to 16.6).
This study found no significant difference in revision rates and knee function in cemented versus cementless TKR at up to 16.6-year follow-up.

Cite this article: EFORT Open Rev 2020;5:793-798. DOI: 10.1302/2058-5241.5.200030

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Most cited references 39

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Assessing the quality of reports of randomized clinical trials: is blinding necessary?

A. Jadad, R Moore, D. Carroll … (1996)

It has been suggested that the quality of clinical trials should be assessed by blinded raters to limit the risk of introducing bias into meta-analyses and systematic reviews, and into the peer-review process. There is very little evidence in the literature to substantiate this. This study describes the development of an instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research and its use to determine the effect of rater blinding on the assessments of quality. A multidisciplinary panel of six judges produced an initial version of the instrument. Fourteen raters from three different backgrounds assessed the quality of 36 research reports in pain research, selected from three different samples. Seven were allocated randomly to perform the assessments under blind conditions. The final version of the instrument included three items. These items were scored consistently by all the raters regardless of background and could discriminate between reports from the different samples. Blind assessments produced significantly lower and more consistent scores than open assessments. The implications of this finding for systematic reviews, meta-analytic research and the peer-review process are discussed.

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The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study.

Marita Cross, Emma Smith, Damian Hoy … (2014)

To estimate the global burden of hip and knee osteoarthritis (OA) as part of the Global Burden of Disease 2010 study and to explore how the burden of hip and knee OA compares with other conditions. Systematic reviews were conducted to source age-specific and sex-specific epidemiological data for hip and knee OA prevalence, incidence and mortality risk. The prevalence and incidence of symptomatic, radiographic and self-reported hip or knee OA were included. Three levels of severity were defined to derive disability weights (DWs) and severity distribution (proportion with mild, moderate and severe OA). The prevalence by country and region was multiplied by the severity distribution and the appropriate disability weight to calculate years of life lived with disability (YLDs). As there are no deaths directly attributed to OA, YLDs equate disability-adjusted life years (DALYs). Globally, of the 291 conditions, hip and knee OA was ranked as the 11th highest contributor to global disability and 38th highest in DALYs. The global age-standardised prevalence of knee OA was 3.8% (95% uncertainty interval (UI) 3.6% to 4.1%) and hip OA was 0.85% (95% UI 0.74% to 1.02%), with no discernible change from 1990 to 2010. Prevalence was higher in females than males. YLDs for hip and knee OA increased from 10.5 million in 1990 (0.42% of total DALYs) to 17.1 million in 2010 (0.69% of total DALYs). Hip and knee OA is one of the leading causes of global disability. Methodological issues within this study make it highly likely that the real burden of OA has been underestimated. With the aging and increasing obesity of the world's population, health professions need to prepare for a large increase in the demand for health services to treat hip and knee OA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.

Steven Kurtz, Kevin Ong, Edmund Lau … (2007)

Over the past decade, there has been an increase in the number of revision total hip and knee arthroplasties performed in the United States. The purpose of this study was to formulate projections for the number of primary and revision total hip and knee arthroplasties that will be performed in the United States through 2030. The Nationwide Inpatient Sample (1990 to 2003) was used in conjunction with United States Census Bureau data to quantify primary and revision arthroplasty rates as a function of age, gender, race and/or ethnicity, and census region. Projections were performed with use of Poisson regression on historical procedure rates in combination with population projections from 2005 to 2030. By 2030, the demand for primary total hip arthroplasties is estimated to grow by 174% to 572,000. The demand for primary total knee arthroplasties is projected to grow by 673% to 3.48 million procedures. The demand for hip revision procedures is projected to double by the year 2026, while the demand for knee revisions is expected to double by 2015. Although hip revisions are currently more frequently performed than knee revisions, the demand for knee revisions is expected to surpass the demand for hip revisions after 2007. Overall, total hip and total knee revisions are projected to grow by 137% and 601%, respectively, between 2005 and 2030. These large projected increases in demand for total hip and knee arthroplasties provide a quantitative basis for future policy decisions related to the numbers of orthopaedic surgeons needed to perform these procedures and the deployment of appropriate resources to serve this need.

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Author and article information

Journal

Journal ID (nlm-ta): EFORT Open Rev

Journal ID (iso-abbrev): EFORT Open Rev

Title: EFORT Open Reviews

Publisher: British Editorial Society of Bone and Joint Surgery

ISSN (Electronic): 2058-5241

Publication date Collection: November 2020

Publication date (Electronic): 13 November 2020

Volume: 5

Issue: 11

Pages: 793-798

Affiliations

[1 ]Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK

[2 ]Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK

[3 ]Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts, USA

[4 ]Kaplan Joint Center, Department of Orthopaedics, Newton-Wellesley Hospital, Newton, Massachusetts, USA

Author notes

[*]Jaimee Tan, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK. Email: tanhuishan95@ 123456gmail.com

Author information

Jaimee H.S. Tan https://orcid.org/0000-0001-7716-9988

Sammy A. Hanna https://orcid.org/0000-0001-7381-701X

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Publisher ID: 10.1302_2058-5241.5.200030

DOI: 10.1302/2058-5241.5.200030

PMC ID: 7722941

PubMed ID: 33312706

SO-VID: 0e34f156-f4e6-41f5-b863-f1106615aa9a

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This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.

Cemented vs. cementless fixation in primary total knee arthroplasty: a systematic review and meta-analysis

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Most cited references 39

Assessing the quality of reports of randomized clinical trials: is blinding necessary?

The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study.

Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.

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