Similar clinical and survival outcomes between robotic-assisted cemented and cementless total knee arthroplasty

Abstract Background: Cemented fixation remains the standard in total knee arthroplasty (TKA), but cementless techniques are gaining popularity, particularly in younger, more active patients. Robotic assistance may improve the accuracy of cementless implantation and promote favorable outcomes. Methods: A retrospective review was conducted of 130 cruciate-retaining primary TKAs performed using the ROSA® robotic-assisted system between October 2021 and September 2023 by a single high-volume surgeon. Patients received either a cementless Persona Trabecular Metal® (n = 80) or cemented Persona® (n = 50) prosthesis. Patient demographics, perioperative data, complications, and revisions were recorded. Patient-reported outcome measures (PROMs) WOMAC, Oxford Knee Score, Knee Society Score, and Forgotten Joint Score-12 were collected preoperatively and at minimum one-year follow-up. Results: Patients in the cementless group were younger (p < 0.001) and more frequently men (p = 0.003). Both groups showed significant improvement in all PROMs from baseline (p < 0.001), with no statistically significant differences in final PROMs between groups. One revision occurred in the cemented group (2.0%) due to stiffness and pain; two manipulations under anesthesia (MUA) were required in the cementless group (2.5%). No differences were observed in operative time or hospital length of stay. Conclusion: At short-term follow-up, cementless and cemented robotic-assisted TKAs demonstrated equivalent improvements in PROMs and survivorship. Cementless implants may represent a viable option in appropriately selected patients, particularly younger individuals, when combined with robotic precision. Long-term data are needed to confirm durability.