Uncemented fixation in total knee replacement: a promising future

Purpose of review: The reemergence of uncemented total knee arthroplasty is being fueled by new materials such as trabecular metal for the tibial and patella components and by the use of hydroxyapatite for bony ingrowth. Screwless, uncemented fixation has also been shown to be effective. This combination of materials, technique, and a return to monoblock construction should improve outcomes of uncemented tibial fixation. Recent findings: Recent studies address the high incidence and the high cost of revision total knee arthroplasty. Efforts are underway to create and test new polyethylenes to reduce polyethylene wear and the formation of particulate debris. Modular prosthesis design and backside wear issues have been investigated in studies of modular and monoblock prostheses. Within the current treatment framework, both cemented and uncemented fixation show good long-term results. Cementless total knee arthroplasty fixation has shown excellent results without screws, which have been implicated in infection and wear complications. Summary: Uncemented prosthesis fixation can yield excellent stability and longevity. Combined with advances in critical areas of total knee arthroplasty technique and materials, uncemented fixation has the potential to improve the longevity of knee replacement and delay the expense and risks of revision surgery.