Global trends in fixation methods for primary total knee arthroplasty: An international registry-based analysis and review of outcomes.

Abstract

Despite the projected growth of total knee arthroplasty (TKA) in the United States (US) and worldwide, there remains debate regarding optimal implant fixation. The purpose of this study was to report the global trends in cementing rates for TKA using available data from national arthroplasty registries. Data were extracted from the annual reports of 7 national joint registries, with annual trends in cementation rates calculated via linear regression. Data regarding revision rates were aggregated from national joint registries, and a literature search identified all meta-analyses published since 2012 that compared outcomes of cemented and cementless fixation. Average rates of cementless fixation over the study period ranged from 1.4 % (Germany) to 15.4 % (Australia). The US led in cementless TKA usage with rates increasing at a rate of 2 % annually (<i>p</i><.001). In European countries, use of cementless fixation remains below 10 % with only Sweden showing increased adoption. Hybrid cementation is used <b>less than cemented or cementless</b> (<10 % of cases/year) in countries analyzed in this study except for Australia which reports upwards of 20 % of cases/year in 2022. Summary of meta-analyses revealed no clear differences in rates of revision, reoperation, infection, range of motion (ROM), or knee society score (KSS). The vast majority of TKAs performed worldwide use cement fixation, but rates of cemented and cementless TKA fixation vary widely by country. Recent meta-analyses generally indicate cementless TKA provides similar outcomes when compared to cemented TKA. In contrast, registry data still associates cemented TKAs with lower revision rates.