Uncemented Total Knee Arthroplasty in the State of Michigan has Higher Rates of Revision Through 5-Year Follow-Up.

Background: While cemented total knee arthroplasty (TKA) is considered the gold standard, uncemented designs are gaining popularity, especially in young men who are at higher risk of cemented failure. Assessing this growth's impact, the Michigan Arthroplasty Registry Collaborative Quality Initiative analyzed adoption rates of uncemented TKA and the effect of fixation technique on revision rates with the goal of assessing the revision rates and survivorship at five years of cemented versus uncemented TKA to further classify which patients may be more ideal candidates for cementless fixation.

Methods: The Michigan Arthroplasty Registry Collaborative Quality Initiative data from 2017 to 2022 was analyzed to determine the survivorship of cemented versus uncemented TKAs. Descriptive statistics, demographics, and implant type were collected. Cumulative percent revision (CPR) was calculated based on the fixation method. The primary endpoint was time for the first revision. Kaplan-Meier survival curves were compared. Subanalyses were performed based on age, sex, body mass index, and implant type. Confidence intervals were set to 95%.

Results: The registry query yielded 147,838 TKAs. There were 18,523 (12.5%) uncemented TKAs. Uncemented TKA use increased yearly from 2017 to 2022 in all groups. Uncemented TKA had higher CPR through five years at all time points versus cemented (3.65 versus 3.19%, P < 0.0001). Uncemented TKA performed worse in both men and women (P < 0.01, P < 0.01). Unexpectedly, men < 55 years had higher CPR at all time points for the four most used implants (P < 0.05).

Conclusions: The use of uncemented TKA has grown in Michigan across all patient subgroups. Uncemented TKAs had an overall higher risk of revision compared to cemented TKAs. The poorer outcomes appeared consistent across sex, age, and implant type. Younger men who are often preferred for uncemented fixation had higher failure rates. This study suggests that surgeons should be mindful of revision rates and patient selection when moving to uncemented TKA.