Research progress of cementless prosthesis in total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TAI Wenshuo ^1,2,3 ^{共同第一作者} , QI Xinzheng ² ^{Δ共同第一作者} , WANG Bo ^2,3,4 ^{Δ共同第一作者} ,  CHAI Wei ^2,3

1. Chinese PLA Medical College, Beijing, 100039, P. R. China;
2. Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, P. R. China;
3. National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P. R. China;
4. School of Medicine, Nankai University, Tianjin, 300071, P. R. China;

Corresponding?author：

CHAI Wei, Email: chaiweiguanjie@sina.com

Keywords：

Total knee arthroplasty; cementless prosthesis; bone ingrowth; hydroxyapatite coating; robotic-assisted surgery; prosthesis survival rate

DOI：

10.7507/1002-1892.202603126

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the technological evolution, clinical advantages, and cutting-edge development trends of cementless prostheses for total knee arthroplasty (TKA), so as to provide a reference for the clinical treatment of end-stage knee osteoarthritis and the research and development of prosthesis technology. Methods Relevant researches and technical achievements over more than 40 years in the field of cementless prostheses for TKA were systematically reviewed. This study focused on iterative upgrades and carried out comprehensive analysis combined with clinical application data and revision-related studies. Results Benefiting from the advantage of cementless fixation, cementless prostheses can effectively avoid bone-cement-related complications. Prosthesis coating materials have undergone multi-generation iterations, and friction-interface materials present favourable prospects for bionic-oriented application. Robot-assisted surgical systems can markedly improve the primary-fixation reliability of biological prostheses.Conclusion Materials and surgical-assisted techniques for cementless prostheses keep being innovated and their clinical outcomes are continuously optimized. Artificial-intelligence-aided surgical planning and patient-specific customized prostheses will become the core research directions in this field.

Citation： TAI Wenshuo, QI Xinzheng, WANG Bo, CHAI Wei. Research progress of cementless prosthesis in total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(9): 1414-1422. doi: 10.7507/1002-1892.202603126 Copy

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2.	Gibon E, Lewallen DG, Larson DR, et al. John N. Insall Award: Randomized clinical trial of cementless versus cemented tibial components: Durable and reliable at a mean 10-years follow-up[J]. J Arthroplasty, 2023, 38(6S): S14-S20.
3.	Mosher ZA, Bolognesi MP, Malkani AL, et al. Cementless total knee arthroplasty: A resurgence-who, when, where, and how?[J]. J Arthroplasty, 2024, 39(9 Suppl 2): S45-S53.
4.	Insall JN, Lachiewicz PF, Burstein AH. The posterior stabilized condylar prosthesis: a modification of the total condylar design. Two to four-year clinical experience[J]. J Bone Joint Surg (Am), 1982, 64(9): 1317-1323.
5.	Scott RD, Volatile TB. Twelve years’ experience with posterior cruciate-retaining total knee arthroplasty[J]. Clin Orthop Relat Res, 1986(205): 100-107.
6.	Ranawat CS, Flynn WF, Saddler S, et al. Long-term results of the total condylar knee arthroplasty. A 15-year survivorship study[J]. Clin Orthop Relat Res, 1993(286): 94-102.
7.	Rand JA, Ilstrup DM. Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties[J]. J Bone Joint Surg (Am), 1991, 73(3): 397-409.
8.	Scuderi GR, Insall JN, Windsor RE, et al. Survivorship of cemented knee replacements[J]. J Bone Joint Surg (Br), 1989, 71(5): 798-803.
9.	Hungerford DS, Krackow KA. Total joint arthroplasty of the knee[J]. Clin Orthop Relat Res, 1985(192): 23-33.
10.	Berger RA, Rosenberg AG, Barden RM, et al. Long-term followup of the Miller-Galante total knee replacement[J]. Clin Orthop Relat Res, 2001(388): 58-67.
11.	Ritter MA, Berend ME, Meding JB, et al. Long-term followup of anatomic graduated components posterior cruciate-retaining total knee replacement[J]. Clin Orthop Relat Res, 2001(388): 51-57.
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19.	Deckey DG, Rosenow CS, Verhey JT, et al. Robotic-assisted total knee arthroplasty improves accuracy and precision compared to conventional techniques[J]. Bone Joint J, 2021, 103-B(6 Supple A): 74-80.
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25.	Botterill J, Khatkar H. The role of hydroxyapatite coating in joint replacement surgery—Key considerations[J/OL]. J Clin Orthop Trauma, 2022, 29: 101874. doi: 10.1016/j.jcot.2022.101874.
26.	Bendich I, Lawrie CM, Riegler V, et al. The impact of component design and fixation on stress shielding after modern total knee arthroplasty[J]. J Arthroplasty, 2022, 37(6S): S221-S225.
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33.	S?balle K, Hansen ES, B-Rasmussen H, et al. Tissue ingrowth into titanium and hydroxyapatite-coated implants during stable and unstable mechanical conditions[J]. J Orthop Res, 1992, 10(2): 285-299.
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1. Shichman I, Roof M, Askew N, et al. Projections and epidemiology of primary hip and knee arthroplasty in medicare patients to 2040-2060[J/OL]. JB JS Open Access, 2023, 8(1). doi: 10.2106/JBJS.OA.22.00112.
2. Gibon E, Lewallen DG, Larson DR, et al. John N. Insall Award: Randomized clinical trial of cementless versus cemented tibial components: Durable and reliable at a mean 10-years follow-up[J]. J Arthroplasty, 2023, 38(6S): S14-S20.
3. Mosher ZA, Bolognesi MP, Malkani AL, et al. Cementless total knee arthroplasty: A resurgence-who, when, where, and how?[J]. J Arthroplasty, 2024, 39(9 Suppl 2): S45-S53.
4. Insall JN, Lachiewicz PF, Burstein AH. The posterior stabilized condylar prosthesis: a modification of the total condylar design. Two to four-year clinical experience[J]. J Bone Joint Surg (Am), 1982, 64(9): 1317-1323.
5. Scott RD, Volatile TB. Twelve years’ experience with posterior cruciate-retaining total knee arthroplasty[J]. Clin Orthop Relat Res, 1986(205): 100-107.
6. Ranawat CS, Flynn WF, Saddler S, et al. Long-term results of the total condylar knee arthroplasty. A 15-year survivorship study[J]. Clin Orthop Relat Res, 1993(286): 94-102.
7. Rand JA, Ilstrup DM. Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties[J]. J Bone Joint Surg (Am), 1991, 73(3): 397-409.
8. Scuderi GR, Insall JN, Windsor RE, et al. Survivorship of cemented knee replacements[J]. J Bone Joint Surg (Br), 1989, 71(5): 798-803.
9. Hungerford DS, Krackow KA. Total joint arthroplasty of the knee[J]. Clin Orthop Relat Res, 1985(192): 23-33.
10. Berger RA, Rosenberg AG, Barden RM, et al. Long-term followup of the Miller-Galante total knee replacement[J]. Clin Orthop Relat Res, 2001(388): 58-67.
11. Ritter MA, Berend ME, Meding JB, et al. Long-term followup of anatomic graduated components posterior cruciate-retaining total knee replacement[J]. Clin Orthop Relat Res, 2001(388): 51-57.
12. Pilliar RM, Lee JM, Maniatopoulos C. Observations on the effect of movement on bone ingrowth into porous-surfaced implants[J]. Clin Orthop Relat Res, 1986(208): 108-113.
13. Volz RG, Nisbet JK, Lee RW, et al. The mechanical stability of various noncemented tibial components[J]. Clin Orthop Relat Res, 1988(226): 38-42.
14. Bobyn JD, Pilliar RM, Cameron HU, et al. The optimum pore size for the fixation of porous-surfaced metal implants by the ingrowth of bone[J]. Clin Orthop Relat Res, 1980(150): 263-270.
15. Carraro F, Bagno A. Tantalum as trabecular metal for endosseous implantable applications[J/OL]. Biomimetics (Basel), 2023, 8(1). doi: 10.3390/biomimetics8010049.
16. Purcell RL, Baral EC, Slaven SE, et al. Bone ongrowth of contemporary cementless tibial components: A retrieval analysis[J]. Arthroplast Today, 2022, 13: 149-153.
17. Bistolfi A, Spezia M, Cipolla A, et al. Vitamin E-stabilized polyethylene shows similar survival rates at minimum 7-year follow-up compared to conventional polyethylene in primary total knee arthroplasty[J/OL]. J Exp Orthop, 2024, 11(3): e12106. doi: 10.1002/jeo2.12106.
18. Helvie PF, Deckard ER, Meneghini RM. Cementless total knee arthroplasty over the past decade: Excellent survivorship in contemporary designs[J]. J Arthroplasty, 2023, 38(6S): S145-S150.
19. Deckey DG, Rosenow CS, Verhey JT, et al. Robotic-assisted total knee arthroplasty improves accuracy and precision compared to conventional techniques[J]. Bone Joint J, 2021, 103-B(6 Supple A): 74-80.
20. Kreuzer S, Brar A, Campanelli V. Dimensional accuracy of TKA cut surfaces with an active robotic system[J]. Comput Assist Surg (Abingdon), 2022, 27(1): 41-49.
21. Woelfle CA, Geller JA, Neuwirth AL, et al. Robotic assistance improves success of cementless component fixation in one total knee arthroplasty system[J]. Knee, 2024, 51: 240-248.
22. Molho D, Vaidya S, O’Sullivan D, et al. Cemented vs cementless robotic-assisted total knee arthroplasty yield similar short-term clinical outcomes[J/OL]. Arthroplast Today, 2024, 27: 101360. doi: 10.1016/j.artd.2024.101360.
23. Chan KCA, Cheung A, Chan PK, et al. Robotic total knee arthroplasty safely reduces length of stay in an Asian public healthcare system[J]. Bone Jt Open, 2025, 6(1): 12-20.
24. Mathey E, Pelletier MH, Walsh WR, et al. Implant strength contributes to the osseointegration strength of porous metallic materials[J/OL]. J Biomech Eng, 2024, 146(10): 101005. doi: 10.1115/1.4065405.
25. Botterill J, Khatkar H. The role of hydroxyapatite coating in joint replacement surgery—Key considerations[J/OL]. J Clin Orthop Trauma, 2022, 29: 101874. doi: 10.1016/j.jcot.2022.101874.
26. Bendich I, Lawrie CM, Riegler V, et al. The impact of component design and fixation on stress shielding after modern total knee arthroplasty[J]. J Arthroplasty, 2022, 37(6S): S221-S225.
27. Gibian JT, Zuke WA, Hood H, et al. Early aseptic tibial loosening is a concern with a modern two-peg cementless total knee arthroplasty design[J]. J Arthroplasty, 2025, 40(3): 678-682.
28. Mikashima Y, Imamura H, Yano K, et al. Low frequency of radiolucent lines in 3D-printed porous-coated tibial cementless baseplate at 1-year follow-up[J/OL]. J Exp Orthop, 2025, 12(3): e70356. doi: 10.1002/jeo2.70356.
29. Stilling M, Madsen F, Odgaard A, et al. Superior fixation of pegged trabecular metal over screw-fixed pegged porous titanium fiber mesh: a randomized clinical RSA study on cementless tibial components[J]. Acta Orthop, 2011, 82(2): 177-186.
30. Polizzotti G, Lamberti A, Mancino F, et al. New Horizons of Cementless Total Knee Arthroplasty[J/OL]. J Clin Med, 2023, 13(1). doi: 10.3390/jcm13010233.
31. Geesink RG, de Groot K, Klein CP. Chemical implant fixation using hydroxyl-apatite coatings. The development of a human total hip prosthesis for chemical fixation to bone using hydroxyl-apatite coatings on titanium substrates[J]. Clin Orthop Relat Res, 1987(225): 147-170.
32. Bauer TW, Geesink RC, Zimmerman R, et al. Hydroxyapatite-coated femoral stems. Histological analysis of components retrieved at autopsy[J]. J Bone Joint Surg (Am), 1991, 73(10): 1439-1452.
33. S?balle K, Hansen ES, B-Rasmussen H, et al. Tissue ingrowth into titanium and hydroxyapatite-coated implants during stable and unstable mechanical conditions[J]. J Orthop Res, 1992, 10(2): 285-299.
34. Peddada KV, Delman CM, Holland CT, et al. Tantalum cementless versus cemented total knee arthroplasty: A meta-analysis of level 1 studies[J/OL]. J Am Acad Orthop Surg Glob Res Rev, 2023, 7(4). doi: 10.5435/JAAOSGlobal-D-22-00219.
35. Li L, Pan C, Zhang X, et al. Efficacy of cementless porous tantalum tibial components versus cemented tibial components in primary total knee arthroplasty: A meta-analysis[J/OL]. Medicine (Baltimore), 2024, 103(14): e37697. doi: 10.1097/MD.0000000000037697.
36. Fokter SK, Gubeljak N, Punzón-Quijorna E, et al. Total knee replacement with an uncemented porous tantalum tibia component: A failure analysis[J/OL]. Materials (Basel), 2022, 15(7). doi: 10.3390/ma15072575.
37. Murr LE, Gaytan SM, Medina F, et al. Next-generation biomedical implants using additive manufacturing of complex, cellular and functional mesh arrays[J]. Philos Trans A Math Phys Eng Sci, 2010, 368(1917): 1999-2032.
38. Koh Y, Park K, Lee J, et al. Total knee arthroplasty application of polyetheretherketone and carbon-fiber-reinforced polyetheretherketone: A review[J]. Mater Sci Eng C Mater Biol Appl, 2019, 100: 70-81.
39. de Ruiter L, Rankin K, Browne M, et al. Decreased stress shielding with a PEEK femoral total knee prosthesis measured in validated computational models[J/OL]. J Biomech, 2021, 118: 110270. doi: 10.1016/j.jbiomech.2021.110270.
40. Cai Z, Qu X, Zhao Y, et al. Preliminary study on immediate postoperative CT images and values of the modular polyetheretherketone based total knee arthroplasty: An observational first-in-human trial[J/OL]. Front Surg, 2022, 9: 809699. doi: 10.3389/fsurg.2022.809699.
41. Vertesich K, Staats K, B?hler C, et al. Long term results of a rotating hinge total knee prosthesis with carbon-fiber reinforced poly-ether-ether-ketone (CFR-PEEK) as bearing material[J/OL]. Front Bioeng Biotechnol, 2022, 10: 845859. doi: 10.3389/fbioe.2022.845859.
42. Dondani JR, Iyer J, Tran SD. Surface treatments of PEEK for osseointegration to bone[J/OL]. Biomolecules, 2023, 13(3): 464. doi: 10.3390/biom13030464.
43. Chen Z, Chen Y, Wang Y, et al. Polyetheretherketone implants with hierarchical porous structure for boosted osseointegration[J/OL]. Biomater Res, 2023, 27(1): 61. doi: 10.1186/s40824-023-00407-5.
44. Wu H, Guo Y, Guo W. Effect of carbon-fiber-reinforced polyetheretherketone on stress distribution in a redesigned tumor-type knee prosthesis: a finite element analysis[J/OL]. Front Bioeng Biotechnol, 2023, 11: 1243936. doi: 10.3389/fbioe.2023.1243936.
45. Folgado J, Fernandes PR, Jacobs CR, et al. Influence of femoral stem geometry, material and extent of porous coating on bone ingrowth and atrophy in cementless total hip arthroplasty: an iterative finite element model[J]. Comput Methods Biomech Biomed Engin, 2009, 12(2): 135-145.
46. Callaghan JJ, Insall JN, Greenwald AS, et al. Mobile-bearing knee replacement: concepts and results[J]. Instr Course Lect, 2001, 50: 431-449.
47. Tigani D, Lamattina L, Puteo N, et al. Novel clinical applications of 3D-printed highly porous titanium for off-the-shelf cementless joint replacement prostheses[J/OL]. Biomimetics (Basel), 2025, 10(9). doi: 10.3390/biomimetics10090634.
48. Stoltz MJ, Mullick M, Smith LS, et al. Primary total knee arthroplasty using a cementless highly porous titanium tibial baseplate: A minimum 10-year follow-up[J]. J Arthroplasty, 2026, 41(6): 1750-1755.
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Chinese Journal of Reparative and Reconstructive Surgery

Research progress of cementless prosthesis in total knee arthroplasty

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