Twenty-year survivorship of cementless anatomic graduated component (AGC) total knee replacement

Merrill A. Ritter, R. Michael Meneghini

Research output: Contribution to journalArticle


Introduction: There is a renewed interest in cementless total knee replacement (TKR) due to improved biomaterials, desire for decreased surgical times and the potential increased longevity of cementless fixation. This study reports the long term results of a cementless TKR system. Methods: Seventy-three cementless TKRs were performed in 47 patients from 1984 to 1986. There were 42 TKRs in women and 31 TKRs in males. The mean age of the patients was 59 years (range, 18 to 79) at surgery. Surgery was performed fora diagnosis of osteoarthritis in 59 knees, rheumatoid arthritis in 8 and osteonecrosis in 3 knees. The TKR system comprised a cobalt chrome femoral component, a monoblock porous plasma sprayed tibial component and a metal backed patella. All three components were implanted without cement and the tibial component was inserted without screws. Clinical and radiographic follow was performed at routine intervals for a minimum 10 years. Results: Fifty three knees obtained a minimum often years clinical and radiographic follow-up. Twenty four knees were followed a minimum of twenty years and no patient was lost to follow-up. Fifteen failures occurred and included 12 revisions for failed metal backed patella components and metallosis. Two tibial components failed due to aseptic loosening at 1.1 and 2.2 years, and one knee suffered a hematogenous infection at 11 years. Excluding the failed metal backed patella failures and single failure for infection, the cumulative Kaplan-Meier Survivorship for the cementless tibial component was 96.8% at 20 years. There were no femoral component failures. Discussion: Cementless TKR is an attractive option for those with disabling knee gonarthrosis, particularly the younger patient. After eliminating the well documented metal backed patella failures, this cementless knee system utilizing a monoblock tibial component without screws demonstrated excellent long term survivorship out to 20 years follow up. This outcome and survivorship data is invaluable and should be strongly considered in the design of the next generation of modern cementless total knee replacement.

Original languageEnglish (US)
Pages (from-to)JUNE
JournalJournal of Bone and Joint Surgery - Series B
Issue numberSUPPL.
StatePublished - Jun 1 2008
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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