Cementless total knee replacement. Nine- to 11-year results and 10-year survivorship analysis.

A pilot project was initiated in 1981 to evaluate cementless total knee arthroplasty. During the first 3 years, 265 Ortholoc I cementless femoral and tibial components were implanted in 202 patients. Sixty knees (39 patients) were lost to followup, and 31 knees (23 patients) were lost because the patients died, leaving 163 knees (129 patients) with 9- to 11-years' followup. One knee loosened during the 9- to 11-year followup period and was revised, and 5 knees were revised for infection. Considering loosening and infection, survival rate at 10 years was 96.7%. Five knees had revision of the patellar and tibial components for wear that began with the patella and later involved the tibial surface. Considering all modes of failure, survival rate at 10 years was 94%. Two years after surgery, 83.0% of patients had no pain, 15.2% had mild pain, 1.8% had moderate pain, and none had severe pain. Five years after surgery, 77.9% of patients had no pain, 12.1% had mild pain, 6.0% had moderate pain, and 4.0% had severe pain. Ten years after surgery, 83.7% of patients had no pain, 6.1% had mild pain, 8.2% had moderate pain, and 2.0% had severe pain. Knee flexion was 110 degrees preoperatively and increased to a mean of 115 degrees at 2 years postoperative, then remained unchanged for the remainder of the followup. Cementless total knee replacement was a reliable and effective means of treating the end-stage arthritic knee. In knees that required revision, excellent bone stock remained and cementless revision was easily accomplished.