Enhanced Improvement and Comparable Survivorship in Cementless vs. Cemented Total Knee Arthroplasty: A 2-Year Analysis of Patient Reported Outcomes and 5-Year Analysis of Implant Survivorship

Abstract Purpose This study aimed to evaluate patient-reported outcomes, functional recovery, satisfaction, and implant survivorship for cementless and cemented TKA. Methods A prospective, non-randomized, multicenter study was conducted on 453 patients. Cohort 1 (n = 373 knees) received a fully cementless construct with the Triathlon Tritanium Tibial Baseplate, Triathlon Tritanium Patella, Triathlon CR or PS Beaded Femur with Peri-Apatite, and the Triathlon Tibial Insert. Cohort 2 (n = 147 knees) received a fully cemented construct with identical implant design. Oxford Knee Score (OKS), 2011 Knee Society Score (KSS), and Short Form 12 (SF12) scores were recorded preoperatively and at six weeks, six months, one year, and two years postoperatively. Implant survivorship and adverse events were also recorded. Results OKS (p = 0.0123), KSS Symptoms for pain (with level walking p = 0.0007; with stairs or incline p = 0.0037), KSS Patient satisfaction (p = 0.0004), and KSS Functional Activities (p = 0.0108) were significantly greater in Cohort 1 out to two years postoperatively. The Kaplan-Meier estimated all-cause survivorship was 98.2% (95% CI: 95.7–99.3%) for Cohort 1 and 97.5% (95% CI: 92.6–99.2%) for Cohort 2 (p = 0.4366). Conclusion Cementless TKA exhibited similar or greater patient outcomes, satisfaction, and function up to two years postoperative, while both cohorts showed comparable rates of adverse events and survivorship at five-year follow-up. This evidence underscores the clinical value and safety of cementless TKA.