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Within the last couple of years, knee replacement surgery has emerged as one of the most successful current developments within the field of orthopedic surgery. With improvements in designs as well as surgical techniques, patients are often presented with a variety of options, which may have different implications for their short-term as well as long-term outcomes. An important option that patients may have includes the cemented vs uncemented knee replacement surgery.
At Orthocenter, patients under the expert care of Dr. Ahmed Shoaib are provided with personalized treatment approaches customized to the individual and evidence-based clinical practice. His specialization in knee replacement surgery allows for the optimal guidance of each patient toward the most appropriate choice for success over the long haul.
In this article, we will look at some key differences between cemented and uncemented knee replacements, so that you can choose the option that is most appropriate for your needs.
In a total knee replacement procedure, the parts of the knee that have become injured are replaced with new artificial parts (or components) that are made out of a combination of metals, ceramics, and high-durability plastics. The new artificial component must be properly secured to the bone so it can function properly in its placement. This method of attaching the component to the bone is called fixation and can be generally divided into two types:
Both methods are common in total knee replacement and have gained success. However, they vary from each other regarding technique, indication for use, and future consideration after total knee replacement.
The cement method of total knee replacement globally comes into use frequently. With this method, bone cement made from polymethyl methacrylate (PMMA) is applied between the implant and the femur. After preparing the surfaces of the femur, the surgeon then places the cement over the top of the joint surface. The cement dries quickly and forms a firm bond between the implant and the bone. This provides immediate stability of the implant from the time of surgery.
Knee replacement surgery, where joint implants are fixed to patients’ bones through biological fixation rather than the cementing of knee implants, is referred to as uncemented knee replacement. Biological fixation occurs as healthy living tissue (bone) grows into the implant surface through specially designed porous coatings on the implant surface.
The surgeon fits the implant very tightly against the patient’s existing bone. Over a period of several weeks to months, the patient’s natural bone grows into the implant’s porous surface. Hence, thereby providing a solid and durable bond.
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Below are the key differences between the methods under discussion:
The main difference is the method of securing the implant. Cemented knee replacements use artificial cement to secure the implant immediately. In contrast, uncemented knee replacements need the body to heal the bone before the implant can become securely attached.
Cemented knee replacements allow the patient to bear weight right away and provide bone support during the patient’s rehabilitation process because cemented knee replacements can immediately fixate the implant. However, uncemented knee replacements may need to have a more conservative approach in the beginning of the recovery process to promote bone ingrowth.
Historically, for older patients, cemented knee replacements work well. However, younger patients (those with greater activity levels) tend to receive uncemented implants. However, advancements in implant technology have contributed to a dissolving distinction between these two types of knee replacement fitments.
Cemented fixation is effective for patients with poor or osteoporotic bone quality, while uncemented fixation is successful when the bone quality is good.
A cemented or uncemented replacement will have a high probability of surviving long-term. Cemented replacements typically survive for 15 to 20+ years, whereas many newer uncemented devices have shown promising results over the long term, especially in younger patients.
Correct handling of cement and correct timing of cementation are critical during cemented knee replacement surgery. On the other hand, precise preparation and positioning during uncemented knee replacement surgery are essential to achieve a tight fit, a level of accuracy typically ensured by orthopedic surgeons.
| Benefits | Drawbacks | |
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| Cemented Knee Replacement |
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| Uncemented Knee Replacement |
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Choosing between cemented vs uncemented knee replacement entails consideration of many factors unique to the patient. It includes age (and activity level), bone density, the degree of knee misalignment, and health conditions (and other possible medical conditions). However, a thorough evaluation of the patient by the surgeon must occur in order to give the patient an accurate understanding of all the factors that can affect their decision regarding the type of knee replacement surgery.
While cemented and uncemented knee replacements have similar protocols for rehabilitation based on early mobilization, pain control, and gradual progression to strengthening. Due to the nature of cemented components, patients sooner receive greater amounts of immediate confidence for weight-bearing. However, with uncemented components, close monitoring is necessary during the first few weeks. Additionally, for excellent results, regular follow-ups and the physiotherapist’s instructions are very important.
In the end, both the cemented and uncemented knee-replacement approaches will provide satisfactory solutions to remove pain and restore knee function; however, cemented fits remain a common option for the majority of patients because of their immediate mechanical stability and proven long-term success.
At the same time, the popularity of uncemented fixation is increasing rapidly for the younger patient population with a greater quality of bone. The ideal treatment technique really depends on each patient’s unique attributes and also on the expertise and experience of knee replacement surgeons to perform successfully with that method.
Moreover, through a detailed evaluation completed at reliable clinics like Orthocenter under the guidance of Dr. Ahmed Shoaib, patients will be provided with a science-backed recommendation based on their individual characteristics. The goal of such evaluations is to provide patients with the safest surgical option to enable them to have a successful recovery and achieve optimal and long-term, sustainable results; therefore, allowing patients to return to their active and pain-free lifestyle.
