Uncemented Total Knee Arthroplasty: An Analysis of Biomechanical, Clinical, and Technological Aspects

Introduction: Total knee arthroplasty (TKA) is widely used for treating advanced osteoarthritis and other degenerative conditions, providing pain relief and improved joint function. Traditionally, cemented TKA is preferred for its reliable initial fixation, especially in elderly patients with compromised bone quality. However, with increasing life expectancy and physical demands, uncemented TKA has emerged as a promising alternative, offering benefits in bone preservation and greater implant durability. This study reviews the biomechanical, clinical, and technological aspects of uncemented TKA compared to cemented TKA.

Objective: To critically evaluate the effectiveness of uncemented TKA, identifying factors that influence long-term outcomes and comparing its benefits and limitations to cemented TKA.

Methods: A review was conducted based on articles published over the last 20 years, including clinical studies, systematic reviews, experimental trials, and observational studies. The search was carried out in the PubMed, Scopus, and Web of Science databases, using specific terms and Boolean operators. Studies were selected according to predefined inclusion and exclusion criteria, and data were extracted and analyzed to compare the outcomes between TKA techniques.

Results: Uncemented TKA showed advantages in preserving bone density and reducing reoperation rates in young and active patients due to osteointegration facilitated by materials such as trabecular titanium and hydroxyapatite coatings. However, challenges persist, particularly in patients with osteoporosis, where fixation may be less effective. On the other hand, cemented TKA offers superior initial stability in older patients.

Conclusion: Uncemented TKA provides significant benefits, especially for younger patients, but the choice between cemented and uncemented TKA should be personalized, considering factors such as age, bone quality, and physical activity level. Ongoing advances in materials and technologies may further improve uncemented TKA outcomes, but additional studies are needed to strengthen the evidence.