Cementless TKA: The preferred method for young, active, and heavy patients

Cementless fixation has the advantage of obtaining biological fixation, which should respond better than cement to the increased stresses that are expected in younger, active, and/or obese patients. In total, 1011 Natural-Knee® cementless total knee replacements were performed by the author from 1986 to 2015 in this patient population. The 10-year failure rates of 20-30% were noted in the early cases, which included the use of metal-backed patellae and use of tibial screws that allowed back-side polyethylene wear debris-induced osteolysis. Reliable bone attachment occurred. The last 760 total knee replacements in this series have been performed with cementless femoral and tibial components, no tibial screws, cemented patellae, and highly cross-linked polyethylene tibia with only one revision for aseptic loosening or osteolysis.