Problems with cementless total knee arthroplasty at 11 years followup

One hundred two patients with 131 consecutive cementless total knee arthrop lasties that retained the posterior cruciate ligament were followed up pros pectively. The average age of the patients was 58 years (range, 32-75 years ). The mean followup on the surviving knee arthroplasties was 11 years (ran ge, 7-16 years). The patellar component was metal-backed in the first 112 ( 85%) knees, cementless all-polyethylene in the last 17 (13%) knees, and two knees had a prior patellectomy. Forty-four metal-backed patellar component s (48%) were revised; nine were loose, and 35 had polyethylene wear through . Thirteen femoral components (12%) were revised because of femoral abrasio n from a failed metal-backed patellar component. No other femoral component was revised, loose, or had osteolysis develop. Nine (8%) tibial components had failure of ingrowth;, eight have been revised. Partial radiolucencies occurred in 53% of the tibias. Thirteen (12%) small osteolytic lesions deve loped, all around screws or screw holes in the tibial components. At an ave rage of 11 years followup, cementless fixation yielded mixed results: cemen tless femoral fixation was excellent and metal-backed patellar components h ad a 48% patellar revision rate. Cementless tibial components had an 8% ase ptic loosening rate and a 12% incidence of small osteolytic lesions. Based on these results, the authors have abandoned cementless fixation in total k nee arthroplasty.