Cementless total knee arthroplasty presently enjoys a success rate equal to cemented designs. Clinical results of early cementless total knee replacements had both design and development problems,1-3 similar to early cemented systems.2,4 Some early cementless knee series had suboptimal results, especially with metal-backed patel-las.5-10 Likewise, just as cemented total knee designs and clinical results improved,11,12 so too have the evolution and clinical results of cementless total knee replacements. Cemented and cementless total knee arthroplasty are similar in respect to requirements for alignment, ligament balancing, and precise bone cuts. In order to achieve durable fixation, cementless fixation may require greater surgical precision than cemented TKA, and is optimized by certain prosthetic design modifications. Cementless fixation may provide several advantages, especially for the younger and more active patient. With increasing life expectancy, a more durable interface would be desirable, especially if bone rather than fibrous tissue attachment could be reproducibly assured. If porous-coated stems and pegs are avoided in the majority of primary total knee replacements, potential future revisions are more bone-sparing.

A number of recent reports indicate that excellent results can be obtained with cementless total knee arthoplasty,13-17 especially if design considerations are coordinated with surgical technique. The authors' 7- to 11-year experience demonstrates that primary cementless fixation in an appropriately selected patient group provides results comparable to cemented TKA with the advantage of conserving bone stock and eliminating the potential problems of methylmethacrylate fixation.18

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