Midterm Results of Cementless Total Knee Arthroplasty: A Retrospective Case Series

Radosław Stempin1, *, Kacper Stempin2, Wiesław Kaczmarek3, Julian Dutka4
1 Department of Orthopedic & Trauma Surgery, J. Strus Memorial (Multispecialistic City) Hospital, Poznan, Poland
2 Department of Orthopedic & Trauma Surgery, Westallgäu Clinic, Wangen, Germany
3 Department of Orthopedic Surgery, Promienista Clinic, Poznan, Poland
4 Department of Orthopedic & Trauma Surgery, S. Zeromski Memorial Hospital Cracow, Poland

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© 2018 Stempin et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Orthopedic & Trauma Surgery, J. Strus Memorial (Multispecialistic City) Hospital, ul. Szwajcarska 3, 61-285 Poznań, Poland; Tel: + 48 601 727 982; E-mail:



There is an ongoing debate about whether to use cementless or cemented fixation for Total Knee Arthroplasty (TKA).


The study aimed to assess midterm survivorship of the Vanguard cementless system, and to demonstrate the utility of the Bone Hardness Test (BHT) for the selection of cementless fixation TKA.


From September 2009 through November 2014, 123 total knee arthroplasties were completed, with cementless Vanguard Cruciate Retaining TKA in 110 knees (102 patients) and cemented Vanguard in 13 cases (12 patients). Implant fixation was based on intraoperative assessment of posterior cruciate ligament stability, bone quality, and BHT. All patients with a cementless Vanguard implant were eligible for this retrospective study. Preoperative and postoperative Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index were obtained. Standardized standing anteroposterior and lateral radiographs were taken.


Three patients (4 TKAs) were lost to follow-up. The mean follow-up time was 5.5 ± 1.4 years. All scores significantly improved postoperatively. No radiographic failures were observed. Five-year implant survival, with revision of any component for any reason as an endpoint, was 97.2% (95% confidence interval, 91.7 - 99.1%). Five-year survival with revision for aseptic loosening was 100%. Only one knee required revision due to an isolated unrelated bearing exchange, and two additional knees required secondary resurfacing of the patella for retropatellar pain.


Good midterm results were obtained with the cementless Vanguard Cruciate Retaining TKA for the treatment of osteoarthritis. The Bone Hardness Test appears to be an effective way to determine the selection of cementless TKA.

Keywords: Osteoarthritis knee, Cementless total knee arthroplasty, Fixation, Bone matrix quality, Bone hardness test, Biocompatible coated materials.