Total knee arthroplasty (TKA) stands undisputed as one of the most effective surgical interventions in all of modern medicine, historically relying on polymethyl methacrylate bone cement as the definitive gold standard for immediate component fixation. However, as the demographics of joint reconstruction continue to shift toward younger, heavier, and substantially more active patients, the structural longevity of the cement mantle has faced intense clinical scrutiny. High joint forces and repetitive torsional stress trigger micro-degradation at the bone-cement interface, culminating in osteolysis and premature mechanical failure.
To bypass this interface degradation, cementless press-fit designs re-emerged. Yet, many high-volume reconstruction specialists remain intensely reluctant to adopt non-cemented pathways due to the catastrophic legacy of mid-1990s designs, which suffered failure rates up to 19% from poor osseointegration, early subsidence, and rapid tibial loosening. We set out to evaluate whether massive modern advancements in basic science, engineering, and highly porous biomaterials have successfully banished those historical design flaws.
