Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching

Abstract

Background: Existing studies of patient-reported outcomes (PRO) following total knee arthroplasty (TKA) based on fixation methods (cemented vs cementless) are limited to single centers with small sample sizes. Using multicentered data,, we compared baseline and early post-operative global and condition-specific PROs between patients undergoing cemented versus cementless TKA.

Methods: With PROs prospectively collected through Comparative Effectiveness Pulmonary Embolism Prevention After Hip and Knee Replacement (PEPPER) trial (ClinicalTrials.gov: NCT02810704), we examined pre- and post-operative (1, 3, and 6-months) outcomes in 5,961 patients undergoing primary TKA enrolled by 28 medical centers between December 2016 and August 2021. Outcomes included the short-form of the Knee Injury and Osteoarthritis Outcome Score (KOOS-Jr.), the Patient-Reported Outcomes Measurement Information System Physical Health (PROMIS-PH), and the Numeric Pain Rating Scale (NPRS). To minimize selection bias, we performed a 1-to-1 propensity score matched analysis to assess relative pre- to post-operative change in outcomes within and between cemented and cementless TKA groups.

Results: With greater than 90% follow-up, significant pre to- post-operative improvements were observed in both groups. At 6 months, the cemented TKA group achieved a 3.3 point (55% of the Minimum Clinically Important Difference) greater improvement in the mean KOOS-Jr. (95%CI: 0.36, 6.30; P = 0.028) than did the cementless group with no significant between-group differences in PROMIS-PH and NPRS.

Conclusions: In a large cohort of primary TKAs, patients with cemented fixation reported early incremental benefit in KOOS-Jr. over those with cementless TKA. Future studies are warranted to capture longer follow-up of PROs.

Keywords: Cemented TKA; Cementless TKA; Knee arthroplasty; Patient-Reported outcomes.

Conflict of interest statement

One or more of the authors (HK, CP, BM) have received funding from Agency for Healthcare Research and Quality (AHRQ). CP received royalties from Total Joint Orthopedics and research support from Zimmer Biomet. CP served as a paid consultant for Simith & Nephew, Total Joint Orthopedics, Zimmer Biomet, 3 M, Haereus, and Immunis. CP holds stock in Joint Development LLC. BM served as a paid consultant on the PEPPER trial, through ownership in STATIX, LLC. VP has nothing to disclose. The PEPPER INVESTIGATORS do have any competing interest.

© 2022. The Author(s).

Figures

Fig. 1

Study cohort and follow-up by implant fixation methods (a) All sample (Before matching) Note: PROs were collected at 1-month, 3-month, and 6-month using centralized telephone interviews, web-based surveys, and postage-paid reply mail surveys. (b) Propensity matched sample (After matching) Note: PROs were collected at 1-month, 3-month, and 6-month using centralized telephone interviews, web-based surveys, and postage-paid reply mail surveys

Fig. 2

Balance plot of study cohort before and after the propensity score matching. Note: Distribution of the propensity scores before and after 1:1 matching between cemented and cementless TKA groups

Fig. 3

PROs following TKA between cemented and cementless fixation in the propensity-matched cohort. Note: Patient-reported outcomes following cemented and cementless total knee arthroplasty. Estimated coefficients were adjusted for age, BMI, gender, race, ethnicity, education, working status, drinking, smoking, and comorbidity

Fig. 4

Proportion of patients achieving MCID at 1, 3, and 6 months among the propensity-matched cohort. Note: Proportion of patients within each group (cemented vs cementless) who achieved the Minimum Clinically Important Difference (MCID) in each patient-reported outcomes (KOOS Jr., PROMIS-10 PH, and NPRS)