Outcomes of cemented versus cementless robotic total knee arthroplasty - A propensity score-matched Asian population-based cohort study.

Abstract

Our study sought to evaluate outcomes following robotic-assisted total knee arthroplasty (TKA) involving cemented and cementless implants. A retrospective study was conducted on patients who underwent unilateral elective robotic TKA at a single tertiary hospital from June 2018 to February 2022. Patients were dichotomized into cementless vs. cemented TKAs. A 1:3 propensity score-matching of the two groups was used to match patients based on age, body mass index, gender and comorbidities. Pre-operative and postoperative knee range of motion (ROM), Knee Society Knee Score (KSKS) and Function Score (KSFS), Oxford Knee Score (OKS), SF-36 score and minimal clinically important difference (MCID) attainment were collated and analyzed. A total of 148 patients were included in the study with 111 patients in the cemented group and 37 patients in the cementless group. Cementless TKAs have a significantly shorter procedure duration (P < 0.001). Postoperatively at 2 years, there was a significant difference between SF-36 Physical Component Summary scores, with the cementless group doing significantly better (P = 0.006). Outcome measures for KSKS, KSFS, OKS and SF-36 Mental Component Summary scores were comparable between the two groups. A higher percentage of patients from the cementless group attained MCID for SF-36 PCS at 6 months (P = 0.030) and 2 years (P = 0.050) post-TKA. Patients undergoing cementless robotic-assisted TKA may potentially have better functional outcomes at 2 years postoperatively. Newer generations of cementless prosthesis designs have improved implant survivorship. With growing technological advancements, a value-driven care approach should be undertaken with thorough evaluation of long-term functional outcomes and cost-effectiveness.