Cemented Versus Noncemented Total Knee Arthroplasty Outcomes

Alexandra Stavrakis, MD; Armin Arshi, MD; Daniel Chiou, MD; Peter Hsiue, MD; John Gabriel Horneff III, MD; Christos Photopoulos, MD

Disclosures

J Am Acad Orthop Surg. 2022;30(6):273-280.

Abstract and Introduction

Abstract

Introduction: Aseptic loosening remains one of the most common indications for revision total knee arthroplasty (TKA). Given the demographic shift to a younger and more active TKA patient population, some surgeons have revisited noncemented fixation given its potential for lower rates of long-term aseptic loosening. The purpose of this study was to compare the demographics and complications between patients undergoing noncemented and cemented TKA.

Methods: Using the MKnee subset of the PearlDiver database, diagnosis and procedure codes were used to identify patients who had undergone cemented or noncemented TKA for osteoarthritis with a minimum 2-year follow-up. Propensity score matching was done to compare risk-adjusted medical and surgical complication profiles at 90 days, 1 year, and 2 years.

Results: Of 203,574 patients identified, 3.2% underwent noncemented TKA and 96.8% underwent cemented TKA. Using propensity-matched analysis, there was no difference in 90-day medical complications. Noncemented TKA was associated with a greater risk of periprosthetic joint infection throughout the study (90-day odds ratio [OR] 1.34, 1-year OR 1.27, 2-year OR 1.27, P < 0.05). Noncemented TKA was associated with a greater risk of periprosthetic fracture at 1 year and 2 years (1 year OR 2.19, 2 years OR 1.89, P< 0.05). No notable difference was observed in risk of aseptic loosening between the two groups.

Abstract and Introduction
Methods
Results
Discussion
References

Table 1. Baseline Patient Demographics
Patient Demographics	Cemented (N = 197,159) (%)	Noncemented (N = 6,415) (%)	P Value
Age, yr
<40	0.32	0.53	0.006
40–49	3.43	6.19	<0.001
50–59	19.30	26.13	<0.001
60–69	37.68	38.52	0.178
≥70	35.48	25.05	<0.001
Sex
Male	35.86	41.57	<0.001
Female	64.14	58.43
CCI
0	57.04	59.88	<0.001
1	19.92	19.73	0.726
2	10.47	9.01	<0.001
3	5.72	5.25	0.116
4	2.79	2.43	0.092
5	4.05	3.69	0.166

CCI = Charlson Comorbidity Index

Table 2. Baseline Patient Comorbidities
Patient Comorbidities	Cemented (N = 197,159) (%)	Noncemented (N = 6,415) (%)	P Value
Diabetes	25.53	26.06	0.343
HTN	61.15	59.33	0.003
Obesity	21.41	24.52	<0.001
Renal disease	7.02	5.85	<0.001
Renal failure	2.42	1.92	0.011
CAD	13.54	12.42	0.010
Ischemic heart disease	5.01	4.26	0.007
CHF	1.82	1.56	0.138
Cardiac valvular disease	7.28	6.24	0.002
Cardiac arrhythmia	11.91	10.79	0.007
PVD	6.50	5.95	0.083
COPD	16.01	16.91	0.056
Liver disease	3.95	4.75	0.001
Rheumatoid arthritis	2.27	1.81	0.017
Hypothyroidism	16.36	15.18	0.013
PUD	1.18	1.34	0.276
HIV	0.16	0.30	0.013
Depression	15.01	15.85	0.065
Dementia	0.65	0.50	0.154
Cancer	6.35	5.52	0.008
Solid tumor no mets	5.86	5.08	0.010
Tobacco use	5.93	6.69	0.013
Alcohol use	1.34	1.76	0.005
Drug abuse	2.12	2.76	<0.001

HTN = hypertension, CAD = coronary artery disease, CHF = congestive heart failure, PVD = peripheral vascular disease, COPD = chronic obstructive pulmonary disease, PUD = peptic ulcer disease, HIV = human immunodeficiency virus

Table 3. Propensity Score-matched Adjusted Univariate Analysis for Medical Complications at 90 Days
Complication	Cemented (%)	Noncemented (%)	OR	95% CI	P Value
Deep vein thrombosis	0.87	0.78	1.43	1.07–1.92	0.201
Pneumonia	0.92	1.04	1.14	0.84–1.54	0.449
Transfusion	0.65	0.83	1.28	0.91–1.81	0.191
Hematoma	0.51	0.59	1.15	0.77–1.72	0.555
Urinary tract infection	3.29	3.59	1.09	0.93–1.29	0.304
Sepsis	0.62	0.72	1.15	0.80–1.66	0.507
Wound disruption	0.97	1.23	1.28	0.96–1.70	0.105

CI = confidence interval, OR = odds ratio

Table 4. Propensity Score-matched Adjusted Univariate Analysis for Surgical Complications at 90 Days
Complication	Cemented (%)	Noncemented (%)	OR	95% CI	P Value
Periprosthetic joint infection	1.28	1.72	1.34	1.06–1.70	0.019
Periprosthetic fracture	0.14	0.17	1.22	0.58–2.59	0.743
Stiffness	10.97	11.62	1.07	0.97–1.17	0.187
Aseptic loosening	0.22	0.22	1	0.53–1.90	1

CI = confidence interval, OR = odds ratio

Table 5. Propensity Score-matched Univariate Analysis for Surgical Complications at 1 Year
Complication	Cemented (%)	Noncemented (%)	OR	95% CI	P Value
Periprosthetic joint infection	1.94	2.45	1.27	1.04–1.55	0.024
Periprosthetic fracture	0.17	0.37	2.19	1.22–3.90	0.011
Stiffness	11.56	12.84	1.13	1.03–1.23	0.011
Aseptic loosening	0.49	0.56	1.14	0.76–1.72	0.593

CI = confidence interval, OR = odds ratio

Table 6. Propensity Score-matched Univariate Analysis for Surgical Complications at 2 Years
Complication	Cemented (%)	Noncemented (%)	OR	95% CI	P Value
Periprosthetic joint infection	2.23	2.83	1.27	1.05–1.52	0.014
Periprosthetic fracture	0.27	0.50	1.89	1.16–3.06	0.013
Stiffness	12.36	13.15	1.07	0.98–1.17	0.127
Aseptic loosening	0.89	1.06	1.20	0.88–1.62	0.280