Cementless medial pivot design demonstrates equal or better outcomes compared to cementless cruciate-retaining design following total knee arthroplasty

Introduction: Traditional total knee arthroplasty (TKA) designs fail to reproduce physiologic knee kinematics, which can contribute to patient dissatisfaction. In an attempt to restore more normal knee kinematics, the medial pivot (MP) design may improve knee function and stability as well as patient satisfaction. A limited number of studies have compared postoperative outcomes of exclusively cementless Cruciate-Retaining (CR) TKAs to cementless MP TKAs. We aimed to compare: (1) 90-day, 1-year, and 2-year complications and revisions, (2) preoperative and postoperative range of motion (ROM), (3) Knee Injury and Osteoarthritis Outcome (KOOS-JR), and (4) visual analog scale (VAS) pain scores at 3-month, 6-month, 1-year, and 2-years.Methods: A retrospective analysis was performed to identify all patients who had previously undergone a TKA at our institution and compare a cementless CR system to a cementless MP design. Categorical variables, including demographics, comorbidities, and complications utilized Chi-square tests in bivariable analysis. Continuous variables, such as age, were compared using Student's t-tests. Significance was defined as p < 0.05.Results: Cementless CR and cementless MP cohorts showed low profiles of postoperative complications and favorable patient-reported outcome measures (PROMs). The MP cohort had lower VAS pain at 1-year (1.70 vs. 3.76, p < 0.001) and 2-years (1.43 vs. 2.60, p < 0.001) and higher ROM at 3-months (118 vs. 100, p < 0.001), 6-months (113 vs. 103, p < 0.0001), and 1-year (117 vs. 110, p = 0.02), respectively.Conclusion: This study is the first comparison of postoperative outcomes between a cementless CR TKA and cementless MP TKA designs. Implant design and fixation type are vital components influencing patient satisfaction after TKA. Pain scores and range of motion favored the cementless MP cohort in comparison to the cementless CR cohort.