Cemented and uncemented fixation of tibial component in total knee arthroplasty (TKA) such as porous tantalum design or hydroxyapatite (HA) coating with screw supplementation are well described. Both methods has perceived advantages and inherent limitations. However, in the current literature there is paucity of studies performing comparative evaluation of these fixation methods.
Aims: Our prospective randomised clinical trial compared cemented and uncemented tibial fixation using Knee Society scores (KSS), Oxford Knee score (OKS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC), radiological parameters and survivorship to determine the best form of tibial fixation.
255 total knee replacements in 212 patients (age 71.41 ± 7.20 years; 62% female) were randomised to one of three tibial component groups (85 each): (I) cemented (II) HA coated with screw (III) porous tantalum monoblock. Cruciate-retaining uncemented femoral and cemented patella components were performed in every case by a single surgeon.
At latest review (mean followup 5.5 years; range 1.5-14.0 years) the mean KSS (group I (81.2), group II (81.3), group III (82.3), p=0.8), mean OKS (group I (40.2), group II (40.7), group III (40.7), p=0.9) and mean WOMAC (group I (12.3), group II (14.2), group III (11.5), p=0.3). Radiologically similar tibial component alignment with no osteolysis in any group. Survivorship was group I (100%), group II (98.8%) and group III (100%). 1 patient in group II was revised for aseptic loosening. Femoral component survivorship was 100% in all groups and there were no periprosthetic infections in any group.
Tibial component fixation using cement or HA coating with screw supplementation or porous tantalum design all have excellent survivorship. Results from current study suggest similar functional and radiological outcomes in the medium to long term with no significant differences between the groups