Increased Survivorship of Cementless versus Cemented TKA in the Morbidly Obese. A Minimum 5-Year Follow-Up

Brent J. Sinicrope, Anthony W. Feher, Samrath J. Bhimani, Langan S. Smith, Steven F. Harwin, Madhusudhan R. Yakkanti, Arthur L. Malkani

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45 Scopus citations


Background: Total knee arthroplasty (TKA) in the morbidly obese patients can be challenging with an increased risk of complications. Studies have shown increased aseptic failures with well-aligned cemented TKAs in the obese patient. The purpose of this study is to determine if TKA in the morbidly obese (body mass index [BMI] ≥ 40) using cementless implants would demonstrate improved results and survivorship compared to cemented TKA at a minimum 5-year follow-up. Methods: This is a retrospective study comparing clinical results of cemented vs cementless primary TKA with a posterior stabilized design TKA in morbidly obese (BMI ≥ 40) patients with minimal 5-year follow-up. There were 108 patients in the cementless group with a mean BMI of 45.6. In the cemented cohort, there were 85 cemented TKAs with a mean BMI of 45.0. Demographic, clinical, surgical, and radiographic data along with complications were extracted for all study patients. Results: There were 5 failures requiring revision in the cementless group, including 1 for aseptic tibial loosening (0.9%). In the cemented group, there were 22 failures requiring revision, including 16 implants for aseptic loosening (18.8%; P =.0001). Survivorship with aseptic loosening as the endpoint was 99.1% in the cementless group vs 88.2% in the cemented cohort at 8 years (P =.02). Conclusion: Morbidly obese patients (BMI ≥ 40) have a higher failure due to aseptic loosening with cemented TKA with decreasing survivorship over time. The use of cementless TKA in morbidly obese patients with the potential of durable long-term biologic fixation and increased survivorship appears to be a promising alternative to mechanical cement fixation.

Original languageEnglish
Pages (from-to)309-314
Number of pages6
JournalJournal of Arthroplasty
Issue number2
StatePublished - Feb 2019


  • aseptic loosening
  • complications
  • morbid obesity
  • survivorship
  • total knee arthroplasty


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