Abstract
Cementless femoral fixation in total knee replacement has proven to be successful in many studies. There is a recent report by Berger et al, on failure of cementless fixation in a high flexion TKR design. This was with a FiberWire material that had good ingrowth characteristics but was not ideal in terms of immediate fixation.
Cementless patellar fixation to date has required a metal backed patella, which has proven to be problematic in most design. For this reason, most surgeons who resurface the patella do so with an all-polyethylene cemented design.
The major controversy is cemented tibial fixation. This is problematic when performed with ancillary screw fixation due to screw osteolysis. There are newer designs that have shown promise but cemented tibial fixation remains the gold standard.
It is true that early designs of cementless hips were associated with poor results, but newer designs have led to cementless fixation in total hip arthroplasty as the gold standard. It is clear that with newer materials, ancillary biologics and improved design that cementless total knee fixation will eventually prevail. At the present time, the wine needs to stay in the cellar for now.
