Improved performance of cementless total knee arthroplasty (TKA)across international registries: a comparative review
Bibliographic record
Abstract
BACKGROUND: Cementless fixation in total knee arthroplasty (TKA) has been associated with higher revision rates in the past. However, due to advancements in design, as well as surgical techniques, cementless TKA performance has significantly improved. The advantages of cementless fixation include reduced cement-related complications, shorter operating times, and the potential benefits of osseointegration. We aim to assess the improvement in revision rates for cementless TKA over the last 9 years based on international registry reports. METHODS: A comprehensive retrospective review was conducted of six major English-speaking knee arthroplasty registries across the world including the National Joint Registry of England and Wales, Northern Islan Isle of Man and Guernsey (herby referred to as British), Swedish, Canadian, American, Australian, and New Zealand National Joint Registry. Data was collected from the year 2014 along with the most recent annual report published: 2022 or 2023. Data points collected included usage rates of cemented and cementless prostheses for primary TKA, their respective revision rates, and indications for revision. RESULTS: Across four databases, there was an average 8.3% increase in the utilization of cementless fixation for primary TKA over the past decade. Three registries reported a reduction in revision rates for cementless fixation. Lower revision rates for cementless compared to cemented TKA were observed in the most recent American (3.2% cemented vs. 2.8% cementless) and New Zealand annual reports (11.8% cemented vs. 4.5% cementless). In 2022, the British registry reported lower rates of revision for infection with cementless fixation (0.56 vs. 0.89). CONCLUSION: International registries demonstrate increased utilization of cementless TKA. Cementless TKA was reported to have lower revision rates in the most recent US and New Zealand annual reports when compared to cemented TKA.
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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 | 0.010 | 0.028 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.013 | 0.019 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".