This within-patient randomized trial compared cemented versus cementless cruciate-retaining TKA in the same patients undergoing bilateral simultaneous surgery. It asks whether cementless fixation delivers better function, less loosening, less osteolysis, or superior survival at more than 20 years. Each patient received one cemented and one cementless knee, eliminating between-patient confounding.
When counseling a young osteoarthritis patient on TKA fixation, this trial tells you the fixation method does not drive the long-term result. The within-patient randomized design is the real strength. Each patient served as their own control, removing activity level, bone quality, and comorbidity as confounders.
The practical lesson: cementless survivorship matched cemented only because cut precision and polyethylene quality were excellent. Cementless is less forgiving and demands accurate planar cuts for osseointegration. The zero-osteolysis result is tied to compression-molded polyethylene, not the fixation itself. Older cementless series with inferior polyethylene reported osteolysis up to 21%.
Apply caution generalizing: these were low-BMI Korean patients with excellent preoperative motion. The findings may not transfer to heavier, more heterogeneous populations.
This within-patient randomized trial compared cemented versus cementless cruciate-retaining TKA in the same patients undergoing bilateral simultaneous surgery. It asks whether cementless fixation delivers better function, less loosening, less osteolysis, or superior survival at more than 20 years. Each patient received one cemented and one cementless knee, eliminating between-patient confounding.
When counseling a young osteoarthritis patient on TKA fixation, this trial tells you the fixation method does not drive the long-term result. The within-patient randomized design is the real strength. Each patient served as their own control, removing activity level, bone quality, and comorbidity as confounders.
The practical lesson: cementless survivorship matched cemented only because cut precision and polyethylene quality were excellent. Cementless is less forgiving and demands accurate planar cuts for osseointegration. The zero-osteolysis result is tied to compression-molded polyethylene, not the fixation itself. Older cementless series with inferior polyethylene reported osteolysis up to 21%.
Apply caution generalizing: these were low-BMI Korean patients with excellent preoperative motion. The findings may not transfer to heavier, more heterogeneous populations.