Risk of Early Manipulation in Cemented Versus Cementless Total Knee Arthroplasty

Strategic Insights -

A recent study has shed light on the risk of early manipulation under anesthesia (MUA) in cemented versus cementless primary total knee arthroplasty (TKA) using technology or manual instrumentation. The research, published in The Journal of Arthroplasty, utilized the American Joint Replacement Registry to compare rates of MUA in cemented and cementless primary TKAs. The findings have significant implications for orthopedic surgeons and patients.

Key Takeaways:

  • The study analyzed 340,841 cases from the American Joint Replacement Registry, with 78,397 (23%) using technology and 262,444 (77%) not using technology during primary surgery.
  • In the technology-assisted TKA group, there were 51,500 (65%) robotic and 26,897 (35%) navigated cases, with 65% of technology-assisted TKAs and 92% of manual TKAs cemented.
  • Multivariable analysis demonstrated significantly higher odds of MUA in cemented TKAs compared to cementless TKAs (odds ratio [OR] 1.95, 95% confidence interval [CI] [1.06 to 3.59]; P = 0.031).
  • Robotic cases had significantly higher odds of MUA with cemented compared to cementless implants (OR 2.38, 95% CI [1.27 to 4.46]; P = 0.007), while there was no difference in MUA related to cementation in the navigated cases (OR 3.53, 95% CI [0.48 to 25.95]; P = 0.22).
  • Cementless TKA did not increase odds of MUA, and further analysis of cement use into technology and manual cohorts showed that robotic-assisted cemented TKAs had higher rates of early MUA than cementless TKA.
  • The research concluded that identification of risk factors leading to early arthrofibrosis may be patient-dependent and further study is required to elucidate any surgical considerations.

Statistics:

  • 340,841 cases analyzed from the American Joint Replacement Registry
  • 78,397 (23%) cases used technology during primary surgery
  • 262,444 (77%) cases did not use technology during primary surgery
  • 51,500 (65%) robotic cases and 26,897 (35%) navigated cases in the technology-assisted TKA group
  • 65% of technology-assisted TKAs and 92% of manual TKAs were cemented
  • Odds ratio (OR) of MUA in cemented TKAs compared to cementless TKAs: 1.95 (95% CI [1.06 to 3.59]; P = 0.031)
  • Odds ratio (OR) of MUA in robotic cases with cemented compared to cementless implants: 2.38 (95% CI [1.27 to 4.46]; P = 0.007)

Sources:

  • The Journal of Arthroplasty, 2025;40(10)
  • Risk of Early Manipulation In Cemented Versus Cementless Total Knee Arthroplasty: an Analysis of the American Joint Replacement Registry
  • American Joint Replacement Registry
  • New York University (NYU) Langone Health, Dept. of Orthopedic Surgery
  • Joshua C. Rozell, New York University (NYU) Langone Health
  • Benjamin C. Schaf, Armin Arshi, Ran Schwarzkopf, Isabella Zaniletti, and Mita De.