Patient selection and management for successful cementless total knee arthroplasty

Total knee arthroplasty (TKA) is a widely performed procedure for end-stage arthritis, with cemented fixation historically dominating owing to its immediate stability and ability to compensate for minor bone defects. However, concerns over the long-term durability of cemented implants, particularly in younger and more active patients, have renewed interest in cementless TKA as a viable alternative. Advances in implant design, including hydroxyapatite coatings and porous metal surfaces, have improved clinical outcomes, reducing early loosening and enhancing biological fixation. Proper patient selection is crucial for the success of cementless TKA. Studies suggest that younger patients, those with good bone quality, and even some elderly or obese individuals may benefit from cementless implants. While initial migration of the tibial component is more pronounced in cementless TKA, research indicates that this stabilizes over time without impacting long-term outcomes. In addition, pharmacologic interventions, such as bisphosphonates and teriparatide, may help enhance periprosthetic bone density and implant fixation. Despite promising results, challenges remain, particularly in patients with osteoporosis, rheumatoid arthritis, and smoking-related bone health issues. Further research is needed to refine selection criteria, optimize surgical techniques, and ensure long-term success. As next-generation cementless implants continue to evolve, ongoing studies will be essential in guiding patient management strategies for improved outcomes.