A case for Cemented Fixation in TKR
J. Roderick Davey, M.D.,
F.R.C.S.(C) Head, Division of
Orthopaedic Surgery Toronto Western Hospital Toronto, Ontario Total
knee arthroplasty (TKA) has become an increasingly popular treatment for advanced
arthritis of the knee joint. The
initial results of TKA done in the early 1970’s were disappointing but
results of the cemented total condylar type design have demonstrated
remarkable longevity in follow-up at 12-15 years. More modern designs of both
cruciate sparing and cruciate sacrificing TKA’s now have overall success
rates of greater than 90% at 10-year follow-up. The
results for cementless TKA have been less satisfactory than those for cement.
Most studies report longer recovery time for the cementless TKA patient.
Although clinical knee scores tend to be similar for both groups at 2-5 years
follow-up the reoperation rate has been reported to be higher in the
cementless group. Patients receiving cementless knees are, on average,
younger than those receiving cemented knees. The cost of cementless
components is normally greater than those for cemented. Blood loss has been
reported to be higher for cementless knees. Operative time may be decreased
in cementless operations as compared to cemented cases. The
results of hybrid TKA with a cemented tibial component and a cementless
femoral component are similar to those of cemented TKA. Contraindications to cementless TKA include (i) old age, (ii) large bone defect requiring extensive bone grafting, (iii) high activity demands, (iv) obesity, and (v) metabolic bone disease. Cemented TKA is the Gold Standard to which cementless TKA has to be compared.  Previous
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