Unilateral Cementless Total Knee Arthroplasty: Approach and Clinical Outcomes

Abstract

Marcelo Horikawa and Pedro Henrique Barbieri Horikawa

Objective: This study aims to analyze the clinical and functional outcomes of unilateral cementless total knee arthroplasty (TKA), evaluating its efficacy, safety, and impact on patient recovery. Additionally, this research compares cementless TKA with the conventional cemented approach, highlighting advantages, disadvantages, and potential complications associated with each technique.

Methods: A retrospective cohort study was conducted on 280 patients who underwent unilateral cementless TKA. Demographic data, comorbidities, and biomechanical parameters were analyzed. Femoral and tibial movements were assessed through radiographic measurements, and functional outcomes were evaluated using clinical scores. Statistical analysis included the Shapiro-Wilk test for normality, the Kruskal-Wallis test for intergroup comparisons, and Dunn’s post-hoc test for pairwise differences. Statistical significance was set at p < 0.05.

Results: Statistically significant differences were found in key biomechanical parameters, particularly in femoral slope (2.10° ± 1.35, p = 0.007), tibial flexion (4.40° ± 2.20, p = 0.009), and tibial extension (2.30° ± 1.60, p = 0.038). These results suggest that cementless TKA requires precise implant positioning to optimize sagittal alignment and post- operative function. Gender distribution showed a predominance of female patients (60.71%), and hypertension was the most prevalent comorbidity (68.93%), reinforcing the need for perioperative cardiovascular risk management. No statistically significant differences were found in tibial varus, tibial valgus, or rotational movements.

Conclusion: The findings support the efficacy and safety of cementless TKA, particularly in younger and active patients with good bone quality. Precise implant positioning is essential to minimize post-operative complications and ensure long-term survivorship. Compared to cemented TKA, cementless fixation presents advantages such as improved osseointegration and reduced cement-related complications but also requires careful patient selection to mitigate the risk of early implant loosening. Future studies should focus on long-term implant survival, functional recovery, and cost- effectiveness to further refine the indications for cementless TKA.

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