No difference between cemented and cementless total knee arthroplasty in young patients: a review of the evidence
Bibliographic record
Abstract
PURPOSE: The present piece of work provides improved knowledge about the evidence related to TKA in patients 60 years of age or younger, with special focus on fixation methods. Main concern of the review is to analyse the difference of survival rate and complications of cemented and cementless implants. METHODS: An electronic search was carried out between October and December 2015, through CINAHL, PubMed and the Cochrane Central Registry of Controlled Trials web databases. Articles in English, Italian, French and Spanish were considered for inclusion. Only peer-reviewed studies with adult patients aged 60 years or less, with diagnosis of osteoarthritis in more than 90% of the subjects, were considered for inclusion. All studies had to report outcomes after TKA with either cemented or cementless fixation technique. RESULTS: No significant differences in terms of clinical, functional and radiological outcomes were found between cemented and cementless implants. Good clinical and functional results were obtained in terms of the Knee Society score and Western Ontario and McMaster Universities Osteoarthritis Index for both techniques. Radiographic results showed that radiolucent lines of <2 mm in width were detected at radiographs, without difference between cemented or cementless implants. Well-conducted trials on cemented versus cementless TKA were carried out in few papers. A survival rate of over 90% was reported in the majority of the studies at a mean follow-up of 8.6 years (range 5-18 years). CONCLUSION: Similar results were observed in terms of functional outcome and survival rates for both cemented and cementless TKAs. High survival rates were reported for both operative techniques and cemented TKA did not offer additional benefit. Assuming that cementless prosthesis allows a stable fixation and reduces the time of operation, the authors recommend the cementless fixation as a primary choice in the investigated patient population. However, evidence is low, and further research is needed. LEVEL OF EVIDENCE: IV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.004 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".