Winner of the 2003 James A. Rand young investigator's award: Early failure of cementless mobile-bearing total knee arthroplasty

A consecutive series of 82 cementless mobile-bearing total knee arthroplasties performed was studied to determine the reliability of cementless tibial component fixation. The indications for surgery in all cases were osteoarthritis with only mild or moderate deformity. Evaluation consisted of a Knee Society clinical score (KSCS) and radiographic evaluation preoperatively and at annual follow-up. Minimum 2-year follow-up was obtained in 73 of 82 knees (89%). Results were compared to those of a subsequent consecutive series of 76 knees (66 with 2-year follow-up) performed with a mobile-bearing TKA with cemented components with the same indications, implant, technique, and length of follow-up. Six of 73 cementless mobile-bearing TKAs (8%) underwent tibial component revision for symptomatic subsidence and failure of ingrowth compared to 0/66 revisions in the cemented group (P<.05). Patients with cementless mobile-bearing TKA also had a significantly lower KSCS (161 versus 184, P<.05), significantly higher incidence of pain rated more than mild (23% versus 7%, P<.01) and a trend toward less arc of motion (106⁰ versus 115⁰, P<.2). The results do not support the hypothesis that mobile-bearing TKA imparts the advantage of reliable tibial bone ingrowth.