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J Knee Surg
DOI: 10.1055/a-2712-4129
Original Article

National Trends in Use and Complications of Cemented, Cementless, Manual, and Robotic-Assisted Total Knee Arthroplasty: 2016-2022

Authors

  • Daniel Finch

    1   Orthopedic Surgery, Tufts Medical Center, Boston, United States (Ringgold ID: RIN1867)

  • John Mazzocco

    2   Orthopaedic Surgery, Tufts Medical Center, Boston, United States (Ringgold ID: RIN1867)

  • Gloria Coden 

    3   Orthopaedic Surgery, New England Baptist Hospital, Boston, United States (Ringgold ID: RIN22313)

  • Hannah I. Travers 

    4   Department of Orthopedics, New England Baptist Hospital, Boston, United States (Ringgold ID: RIN22313)

  • David Mattingly

    5   Department of Orthopedic Surgery, New England Baptist Hospital, Boston, United States (Ringgold ID: RIN22313)
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Introduction: Cementless total knee arthroplasty (TKA) has become a viable option in recent years, and there has been an increase in robotic-assisted technology. While institutions may monitor their implant usage, the evolution of their use and complication rates have not been well described on a national level in the United States. Therefore, we sought to characterize the use and compare complications between cemented, cementless, manual, and robotic-assisted TKA across the United States. Methods: We retrospectively reviewed a commercial claims database and found 94,603 inpatient primary TKAs that were performed with cemented or cementless components between 1/1/2016 and 12/31/2022. Records were reviewed for demographics, use of robotics, complications, and readmissions up to 90 days postoperatively. Results: More cementless TKAs were performed each year, from 4.1% in 2016 to 12.3% in 2022 (odds ratio (OR)=1.3, p<0.001). The use of robotic technology increased each year from 7.7% in 2016 to 25.0% in 2022 (OR=1.3, p<0.001) and was more commonly used with cementless TKA (OR=1.3, p<0.001). Patient factors associated with cementless TKA included younger age (OR=1.0, p<0.001) and male sex (OR=1.3, p<0.001). Cementless TKA was a risk factor for explantation within 90 days postoperatively (OR=1.5, p=0.008), but not aseptic loosening (OR=0.8, p=0.6), periprosthetic fracture (OR=0.2, p=0.2), infection (OR=1.3, p=0.1), revision TKA (OR=1.4, p=0.1), manipulation under anesthesia (OR=1.0, p=0.9), deep vein thrombosis (OR=0.9, p=0.5), pulmonary embolism (OR=1.2, p=0.3), or blood transfusion (OR=0.3, p=0.1). Conclusion: The use of cementless and robotic TKA is increasing each year, although most inpatient primary TKAs are still performed with manual cemented technique. While cementless TKA was found to be a risk factor for revision and explanation within 90 days, it was not associated with a specific cause of revision. Further research is needed to better understand why cementless TKA increases these risks.



Publication History

Received: 17 February 2025

Accepted after revision: 26 September 2025

Accepted Manuscript online:
30 September 2025

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