Effectiveness of cementless total knee arthroplasty with three-dimensional-printed trabecular metal interface_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHAI Hao , SUN Yongqiang , CHEN Xiaobo , LI Yang ,  LI Shuailei

The 1st Department of Arthroplasty Revision, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou Henan, 450003, P. R. China;

Corresponding?author：

LI Shuailei, Email: joint999@126.com

Keywords：

Total knee arthroplasty; cementless prosthesis; cemented prosthesis; survival rate

DOI：

10.7507/1002-1892.202605035

Video：

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Objective To investigate the short- and mid-term effectiveness and prosthesis survival rate in patients undergoing total knee arthroplasty (TKA) using domestic cementless knee prostheses with three-dimensional (3D)-printed trabecular metal interface. Methods A retrospective analysis was performed on the clinical data of 79 patients who underwent primary TKA for end-stage knee disorders, met the selection criteria and were treated between December 2021 and March 2022. There were 39 patients in the cementless group receiving cementless knee prostheses with 3D-printed trabecular metal interface, and 40 patients in the cemented group adopting posterior-stabilized cement-fixed knee prostheses. Baseline data including age, gender, body weight, disease type, disease duration, and preoperative Knee Society Score (KSS) (clinical score and function score) showed no significant differences between the two groups (P>0.05). Operation time, intraoperative blood loss, and complications were recorded and compared between groups. KSS clinical and function scores before operation and at last follow-up were used to evaluate knee functional recovery. Radiographic assessment was conducted to detect prosthesis loosening, osteolysis, prosthesis subsidence, joint dislocation, and other abnormalities. Prosthesis survival rate was calculated with complete or partial prosthesis removal defined as the endpoint event, and Kaplan-Meier method was adopted to plot prosthesis survival curves. Results All patients successfully completed surgery. No significant intergroup differences were found in operation time and intraoperative blood loss (P>0.05). All patients in the cementless group and cemented group were followed up for (28.4±2.4) months and (28.2±2.8) months respectively, without significant difference (t=?0.274, P=0.785). At last follow-up, both KSS clinical and function scores were significantly higher than preoperative values in both groups (P<0.05), while no significant intergroup differences were observed in the changes of each score (P>0.05). X-ray films at last follow-up revealed no prosthesis loosening, osteolysis, prosthesis subsidence, or joint dislocation in any patient. During follow-up, 5 cases of intermuscular venous thrombosis occurred in the cementless group; in the cemented group, there were 6 cases of intermuscular venous thrombosis, 1 case of poor wound healing, 1 case of periprosthetic joint infection, 1 case of periprosthetic fracture, and 1 case of all-cause death. The complication rates of the two groups (12.8% vs 25.0%) were not different (P>0.05). One revision surgery was performed for periprosthetic joint infection and 1 for periprosthetic fracture in the cemented group, corresponding to a prosthesis survival rate of 95.0%; no endpoint events occurred in the cementless group, with a prosthesis survival rate of 100.0%. Kaplan-Meier survival curve analysis demonstrated no significant difference in prosthesis survival rates between the two groups (Log-rank test: χ²=2.028, P=0.154). Conclusion TKA performed with domestic cementless knee prostheses featuring 3D-printed trabecular metal interface shows no obvious disadvantages compared with cemented prostheses in terms of postoperative function, complication rate, and prosthesis survival rate, which represents a safe and viable prosthesis option.

Citation： CHAI Hao, SUN Yongqiang, CHEN Xiaobo, LI Yang, LI Shuailei. Effectiveness of cementless total knee arthroplasty with three-dimensional-printed trabecular metal interface. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(9): 1372-1377. doi: 10.7507/1002-1892.202605035 Copy

1.	Bourne MH, Miller TL, Mariani EM. Cumulative incidence of revision for a balanced knee system at a mean 8-year follow-up: A retrospective review of 500 consecutive total knee arthroplasties[J/OL]. Adv Orthop, 2019, 2019: 9580586. doi: 10.1155/2019/9580586.
2.	Asokan A, Plastow R, Kayani B, et al. Cementless knee arthroplasty: a review of recent performance[J]. Bone Jt Open, 2021, 2(1): 48-57.
3.	Chiou D, Li AK, Upfill-Brown A, et al. Cementless compared to cemented total knee arthroplasty is associated with more revisions within 1 year of index surgery[J/OL]. Arthroplast Today, 2023, 21: 101122. doi: 10.1016/j.artd.2023.101122.
4.	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.
5.	Zhou K, Yu H, Li J, et al. No difference in implant survivorship and clinical outcomes between full-cementless and full-cemented fixation in primary total knee arthroplasty: A systematic review and meta-analysis[J]. Int J Surg, 2018, 53: 312-319.
6.	Martimbianco ALC, Calabrese FR, Iha LAN, et al. Reliability of the “American Knee Society Score”(AKSS)[J]. Acta Ortop Bras, 2012, 20(1): 34-38.
7.	Miller AJ, Nadar AC, Granade CM, et al. Cementless versus cemented total knee arthroplasty using the same implant design: A mean 5-year follow-up study[J]. J Knee Surg, 2024, 37(10): 724-729.
8.	Goh GS, Fillingham YA, Sutton RM, et al. Cemented versus cementless total knee arthroplasty in obese patients with body mass index ≥35 kg/m²: A contemporary analysis of 812 patients[J]. J Arthroplasty, 2022, 37(4): 688-693.
9.	Niemel?inen MJ, M?kel? KT, Robertsson O, et al. The effect of fixation type on the survivorship of contemporary total knee arthroplasty in patients younger than 65 years of age: a register-based study of 115, 177 knees in the Nordic Arthroplasty Register Association (NARA) 2000-2016[J]. Acta Orthop, 2020, 91(2): 184-190.
10.	Salem HS, Tarazi JM, Ehiorobo JO, et al. Cementless fixation for total knee arthroplasty in various patient populations: A literature review[J]. J Knee Surg, 2020, 33(9): 848-855.
11.	Abdel MP, Bonadurer GF 3rd, Jennings MT, et al. Increased aseptic tibial failures in patients with a BMI ≥35 and well-aligned total knee arthroplasties[J]. J Arthroplasty, 2015, 30(12): 2181-2184.
12.	Sinicrope BJ, Feher AW, Bhimani SJ, et al. Increased survivorship of cementless versus cemented TKA in the morbidly obese. A minimum 5-year follow-up[J]. J Arthroplasty, 2019, 34(2): 309-314.
13.	Chen C, Li R. Cementless versus cemented total knee arthroplasty in young patients: a meta-analysis of randomized controlled trials[J/OL]. J Orthop Surg Res, 2019, 14(1): 262. doi: 10.1186/s13018-019-1293-8.
14.	Meehan JP, Danielsen B, Kim SH, et al. Younger age is associated with a higher risk of early periprosthetic joint infection and aseptic mechanical failure after total knee arthroplasty[J]. J Bone Joint Surg (Am), 2014, 96(7): 529-535.
15.	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.
16.	Ritter MA, Meneghini RM. Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty[J]. J Arthroplasty, 2010, 25(4): 507-513.
17.	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.
18.	Chen AG, Sogbein OA, McCalden RW, et al. Survivorship of modern cementless total knee arthroplasty: Analysis from the Canadian joint replacement registry[J]. J Arthroplasty, 2025, 40(2): 380-385.
19.	Beaupré LA, al-Yamani M, Huckell JR, et al. Hydroxyapatite-coated tibial implants compared with cemented tibial fixation in primary total knee arthroplasty. A randomized trial of outcomes at five years[J]. J Bone Joint Surg (Am), 2007, 89(10): 2204-2211.
20.	Horváth T, Hanák L, Hegyi P, et al. Hydroxyapatite-coated implants provide better fixation in total knee arthroplasty. A meta-analysis of randomized controlled trials[J/OL]. PLoS One, 2020, 15(5): e0232378. doi: 10.1371/journal.pone.0232378.
21.	Pulido L, Abdel MP, Lewallen DG, et al. The Mark Coventry Award: Trabecular metal tibial components were durable and reliable in primary total knee arthroplasty: a randomized clinical trial[J]. Clin Orthop Relat Res, 2015, 473(1): 34-42.
22.	Hampton M, Mansoor J, Getty J, et al. Uncemented tantalum metal components versus cemented tibial components in total knee arthroplasty: 11- to 15-year outcomes of a single-blinded randomized controlled trial[J]. Bone Joint J, 2020, 102-B(8): 1025-1032.
23.	Karachalios T, Komnos G, Amprazis V, et al. A 9-year outcome study comparing cancellous titanium-coated cementless to cemented tibial components of a single knee arthroplasty design[J]. J Arthroplasty, 2018, 33(12): 3672-3677.
24.	Waddell DD, Sedacki K, Yang Y, et al. Early radiographic and functional outcomes of a cancellous titanium-coated tibial component for total knee arthroplasty[J]. Musculoskelet Surg, 2016, 100(1): 71-74.

1. Bourne MH, Miller TL, Mariani EM. Cumulative incidence of revision for a balanced knee system at a mean 8-year follow-up: A retrospective review of 500 consecutive total knee arthroplasties[J/OL]. Adv Orthop, 2019, 2019: 9580586. doi: 10.1155/2019/9580586.
2. Asokan A, Plastow R, Kayani B, et al. Cementless knee arthroplasty: a review of recent performance[J]. Bone Jt Open, 2021, 2(1): 48-57.
3. Chiou D, Li AK, Upfill-Brown A, et al. Cementless compared to cemented total knee arthroplasty is associated with more revisions within 1 year of index surgery[J/OL]. Arthroplast Today, 2023, 21: 101122. doi: 10.1016/j.artd.2023.101122.
4. 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.
5. Zhou K, Yu H, Li J, et al. No difference in implant survivorship and clinical outcomes between full-cementless and full-cemented fixation in primary total knee arthroplasty: A systematic review and meta-analysis[J]. Int J Surg, 2018, 53: 312-319.
6. Martimbianco ALC, Calabrese FR, Iha LAN, et al. Reliability of the “American Knee Society Score”(AKSS)[J]. Acta Ortop Bras, 2012, 20(1): 34-38.
7. Miller AJ, Nadar AC, Granade CM, et al. Cementless versus cemented total knee arthroplasty using the same implant design: A mean 5-year follow-up study[J]. J Knee Surg, 2024, 37(10): 724-729.
8. Goh GS, Fillingham YA, Sutton RM, et al. Cemented versus cementless total knee arthroplasty in obese patients with body mass index ≥35 kg/m²: A contemporary analysis of 812 patients[J]. J Arthroplasty, 2022, 37(4): 688-693.
9. Niemel?inen MJ, M?kel? KT, Robertsson O, et al. The effect of fixation type on the survivorship of contemporary total knee arthroplasty in patients younger than 65 years of age: a register-based study of 115, 177 knees in the Nordic Arthroplasty Register Association (NARA) 2000-2016[J]. Acta Orthop, 2020, 91(2): 184-190.
10. Salem HS, Tarazi JM, Ehiorobo JO, et al. Cementless fixation for total knee arthroplasty in various patient populations: A literature review[J]. J Knee Surg, 2020, 33(9): 848-855.
11. Abdel MP, Bonadurer GF 3rd, Jennings MT, et al. Increased aseptic tibial failures in patients with a BMI ≥35 and well-aligned total knee arthroplasties[J]. J Arthroplasty, 2015, 30(12): 2181-2184.
12. Sinicrope BJ, Feher AW, Bhimani SJ, et al. Increased survivorship of cementless versus cemented TKA in the morbidly obese. A minimum 5-year follow-up[J]. J Arthroplasty, 2019, 34(2): 309-314.
13. Chen C, Li R. Cementless versus cemented total knee arthroplasty in young patients: a meta-analysis of randomized controlled trials[J/OL]. J Orthop Surg Res, 2019, 14(1): 262. doi: 10.1186/s13018-019-1293-8.
14. Meehan JP, Danielsen B, Kim SH, et al. Younger age is associated with a higher risk of early periprosthetic joint infection and aseptic mechanical failure after total knee arthroplasty[J]. J Bone Joint Surg (Am), 2014, 96(7): 529-535.
15. 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.
16. Ritter MA, Meneghini RM. Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty[J]. J Arthroplasty, 2010, 25(4): 507-513.
17. 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.
18. Chen AG, Sogbein OA, McCalden RW, et al. Survivorship of modern cementless total knee arthroplasty: Analysis from the Canadian joint replacement registry[J]. J Arthroplasty, 2025, 40(2): 380-385.
19. Beaupré LA, al-Yamani M, Huckell JR, et al. Hydroxyapatite-coated tibial implants compared with cemented tibial fixation in primary total knee arthroplasty. A randomized trial of outcomes at five years[J]. J Bone Joint Surg (Am), 2007, 89(10): 2204-2211.
20. Horváth T, Hanák L, Hegyi P, et al. Hydroxyapatite-coated implants provide better fixation in total knee arthroplasty. A meta-analysis of randomized controlled trials[J/OL]. PLoS One, 2020, 15(5): e0232378. doi: 10.1371/journal.pone.0232378.
21. Pulido L, Abdel MP, Lewallen DG, et al. The Mark Coventry Award: Trabecular metal tibial components were durable and reliable in primary total knee arthroplasty: a randomized clinical trial[J]. Clin Orthop Relat Res, 2015, 473(1): 34-42.
22. Hampton M, Mansoor J, Getty J, et al. Uncemented tantalum metal components versus cemented tibial components in total knee arthroplasty: 11- to 15-year outcomes of a single-blinded randomized controlled trial[J]. Bone Joint J, 2020, 102-B(8): 1025-1032.
23. Karachalios T, Komnos G, Amprazis V, et al. A 9-year outcome study comparing cancellous titanium-coated cementless to cemented tibial components of a single knee arthroplasty design[J]. J Arthroplasty, 2018, 33(12): 3672-3677.
24. Waddell DD, Sedacki K, Yang Y, et al. Early radiographic and functional outcomes of a cancellous titanium-coated tibial component for total knee arthroplasty[J]. Musculoskelet Surg, 2016, 100(1): 71-74.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of cementless total knee arthroplasty with three-dimensional-printed trabecular metal interface

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