Cementless Fixation

Cementless total knee arthroplasty (TKA) is a surgical technique that aims to achieve biological fixation between the prosthesis and the host bone without the use of bone cement. This approach offers advantages such as bone preservation, avoidance of cement debris complications, and long-term fixation, which is particularly beneficial in younger patients with good bone quality. However, achieving initial fixation remains a challenge, requiring improvements in implant design, materials (such as porous or hydroxyapatite (HA)-coated surfaces) and intraoperative techniques to ensure soft tissue balance. Cementless fixation has evolved from early press-fit designs to modern implants with advanced coatings and materials such as titanium alloys, porous tantalum and 3D printed titanium. Research highlights the importance of screws and sleeves in improving the stability of tibial components, although their role diminishes once biological fixation is achieved. Bone grafting for tibial defects remains problematic, with studies suggesting that it may not be ideal for achieving stable fixation. Initial gaps (IG) between bone and prosthesis, which are common after surgery, can be reduced with HA and porous tantalum, improving early fixation. Long-term results of cementless TKA are promising, with high survival rates and good functional outcomes reported over 10–20 years. While challenges such as postoperative bleeding and stress shielding affecting bone density remain, continued advances in biomaterials and surgical techniques are expected to improve patient outcomes and satisfaction.