National Trends in Use and Complications of Cemented, Cementless, Manual, and Robotic-Assisted Total Knee Arthroplasty: 2016-2022.

Introduction: Cementless total knee arthroplasty (TKA) has become a viable option in recent years, and there has been an increase in robotic-assisted technology. While institutions may monitor their implant usage, the evolution of their use and complication rates have not been well described on a national level in the United States. Therefore, we sought to characterize the use and compare complications between cemented, cementless, manual, and robotic-assisted TKA across the United States.

Methods: We retrospectively reviewed a commercial claims database and found 94,603 inpatient primary TKAs that were performed with cemented or cementless components between 1/1/2016 and 12/31/2022. Records were reviewed for demographics, use of robotics, complications, and readmissions up to 90 days postoperatively.

Results: More cementless TKAs were performed each year, from 4.1% in 2016 to 12.3% in 2022 (odds ratio (OR)=1.3, p<0.001). The use of robotic technology increased each year from 7.7% in 2016 to 25.0% in 2022 (OR=1.3, p<0.001) and was more commonly used with cementless TKA (OR=1.3, p<0.001). Patient factors associated with cementless TKA included younger age (OR=1.0, p<0.001) and male sex (OR=1.3, p<0.001). Cementless TKA was a risk factor for explantation within 90 days postoperatively (OR=1.5, p=0.008), but not aseptic loosening (OR=0.8, p=0.6), periprosthetic fracture (OR=0.2, p=0.2), infection (OR=1.3, p=0.1), revision TKA (OR=1.4, p=0.1), manipulation under anesthesia (OR=1.0, p=0.9), deep vein thrombosis (OR=0.9, p=0.5), pulmonary embolism (OR=1.2, p=0.3), or blood transfusion (OR=0.3, p=0.1).

Conclusion: The use of cementless and robotic TKA is increasing each year, although most inpatient primary TKAs are still performed with manual cemented technique. While cementless TKA was found to be a risk factor for revision and explanation within 90 days, it was not associated with a specific cause of revision. Further research is needed to better understand why cementless TKA increases these risks.