A Systematic Review of Registry and Large Database Studies Comparing Contemporary Cementless and Cemented Total Knee Arthroplasty.

Abstract

Interest is growing in durable, cementless fixation in total knee arthroplasty (TKA). This study aimed to systematically review registry and large database studies, evaluating their quality of evidence and assessing implant survivorship. Additionally, we compared these findings to a systematic review of randomized controlled trials. A search of PubMed and Embase was conducted to identify eligible registry and large database studies on contemporary cementless TKA survivorship published between January 1, 2010, and December 31, 2024. Overlapping studies from the same registry were excluded. Modified Coleman methodology (MCM) scores were used to assess methodological quality, with a score of 85 to 100 considered excellent, 70 to 84 considered good, 55 to 69 considered fair, and below 55 considered poor. In addition, level of evidence assessments were made. Among eight included registry studies, the mean MCM score was 35.5 (range, 29 to 39), reflecting poor quality, and all were level III evidence. Differences in revision rates between cementless and cemented TKA were typically less than 1%. Cementless prostheses comprised less than 5% of total implants evaluated for most studies, with one study evaluating 1,056,492 cemented versus 26,768 cementless TKAs. For the two large database studies, the mean MCM score was low at 36.0 (range, 35 to 37), and both were level II evidence. Of these, one included only a 1-year follow-up, and neither reported specific implant survivorship. However, a recent systematic review of contemporary cementless TKA included 27 randomized controlled trials with a mean MCM score of 76.9 (range, 61 to 91), indicating good quality. Registry and large database studies on contemporary cementless TKA have limited comparative data, often of lower methodological quality, with cementless implants representing a small proportion of cases. Despite these shortcomings, results for survivorship are generally similar for cementless and cemented TKAs.