{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T23:54:11Z","timestamp":1782863651309,"version":"3.54.5"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arthroplasty"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Total knee arthroplasty (TKA) is an effective treatment for advanced gonarthrosis. This retrospective study compares cementless versus hybrid fixation in TKA, an under-investigated comparison in the literature, to describe mid-term clinical, radiographic, and perioperative outcomes between both fixation strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 166 patients (age 50\u201370, adequate bone quality) undergoing primary cruciate-retaining TKA from November 2019 to May 2024. Fixation type was selected by the treating surgeons according to intraoperative assessment of tibial bone stock and press-fit stability. Patients were divided into two groups based on fixation: uncemented (cementless) vs. hybrid (cementless femoral, cemented tibial). Clinical (pain, function) and radiographic outcomes, perioperative complications, and surgical time were compared. Functional outcomes were assessed with Hospital for Special Surgery (HSS) and WOMAC scores; quality of life with the EQ-5D. A propensity score-matched analysis (1:1) was additionally performed to mitigate measured baseline confounding, matching on age, sex, body mass index (BMI), Charlson comorbidity index and preoperative HSS score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean follow-up was 36.8\u2009\u00b1\u200918.7\u00a0months. Uncemented fixation was associated with significantly shorter surgical time (65.2\u2009\u00b1\u200912.4 vs. 78.6\u2009\u00b1\u200915.1\u00a0min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032), a modestly greater postoperative pain reduction on the VAS (7.25\u2009\u00b1\u20092.02 vs. 6.41\u2009\u00b1\u20091.94 points;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012), and a lower observed rate of late complications (1.2% vs. 10.8%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028) compared to hybrid. The incidence of aseptic loosening was lower in the uncemented group (0.0% vs. 3.6%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029), as was the presence of radiolucent lines (6.0% vs. 18.1%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032). No significant differences were found in postoperative range of motion, HSS score improvements, WOMAC, or EQ-5D index between groups. The propensity-matched sub-analysis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009150) yielded directionally consistent findings, although these analyses reduce but do not eliminate residual confounding and remain underpowered for rare outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cementless TKA was associated with comparable mid-term functional outcomes to hybrid fixation, together with shorter operative time and lower observed rates of radiolucent lines and late complications. The difference in pain reduction was statistically significant but modest, and radiographic findings and rare events should be viewed as hypothesis-generating rather than as evidence of superior fixation performance or long-term implant durability. These findings suggest that cementless fixation may represent a reasonable alternative to hybrid fixation in appropriately selected patients, although longer-term prospective comparative studies are required to confirm implant survivorship and clarify the clinical relevance of these observations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42836-026-00399-2","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T23:04:08Z","timestamp":1782860648000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cementless versus hybrid fixation in primary total knee arthroplasty: a propensity score-matched analysis of mid-term outcomes"],"prefix":"10.1186","volume":"8","author":[{"given":"Juan Miguel","family":"G\u00f3mez-Palomo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"de la Varga-Cebri\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Mart\u00ednez-Crespo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Tara-Abad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Aguilar-L\u00f3pez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pl\u00e1cido","family":"Zamora-Navas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"issue":"1","key":"399_CR1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-021-02299-4","volume":"16","author":"Y Liu","year":"2021","unstructured":"Liu Y, Zeng Y, Wu Y, Li M, Xie H, Shen B. A comprehensive comparison between cementless and cemented fixation in the total knee arthroplasty: an updated systematic review and meta-analysis. J Orthop Surg Res. 2021;16(1):176. https:\/\/doi.org\/10.1186\/s13018-021-02299-4.","journal-title":"J Orthop Surg Res"},{"issue":"4","key":"399_CR2","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1055\/s-0030-1247837","volume":"21","author":"R Meneghini","year":"2008","unstructured":"Meneghini R, Hanssen A. Cementless fixation in total knee arthroplasty: past, present, and future. J Knee Surg. 2008;21(4):307\u201314. https:\/\/doi.org\/10.1055\/s-0030-1247837.","journal-title":"J Knee Surg"},{"issue":"4","key":"399_CR3","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1007\/s00264-015-3031-0","volume":"40","author":"M Zingg","year":"2016","unstructured":"Zingg M, Miozzari HH, Fritschy D, Hoffmeyer P, L\u00fcbbeke A. Influence of body mass index on revision rates after primary total knee arthroplasty. Int Orthop. 2016;40(4):723\u20139. https:\/\/doi.org\/10.1007\/s00264-015-3031-0.","journal-title":"Int Orthop"},{"issue":"7","key":"399_CR4","doi-asserted-by":"publisher","first-page":"536","DOI":"10.2106\/JBJS.M.00131","volume":"96","author":"VK Aggarwal","year":"2014","unstructured":"Aggarwal VK, Goyal N, Deirmengian G, Rangavajulla A, Parvizi J, Austin MS. Revision total knee arthroplasty in the young patient: is there trouble on the horizon? J Bone Joint Surg Am. 2014;96(7):536\u201342. https:\/\/doi.org\/10.2106\/JBJS.M.00131.","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"399_CR5","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1016\/j.arth.2020.08.052","volume":"36","author":"R Walker-Santiago","year":"2021","unstructured":"Walker-Santiago R, Tegethoff JD, Ralston WM, Keeney JA. Revision total knee arthroplasty in young patients: higher early reoperation and rerevision. J Arthroplasty. 2021;36(2):653\u20136. https:\/\/doi.org\/10.1016\/j.arth.2020.08.052.","journal-title":"J Arthroplasty"},{"issue":"1","key":"399_CR6","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1055\/s-0037-1608933","volume":"31","author":"M Roche","year":"2018","unstructured":"Roche M, Law T, Kurowicki J, Rosas S, Rush A. Effect of obesity on total knee arthroplasty costs and revision rate. J Knee Surg. 2018;31(1):38\u201342. https:\/\/doi.org\/10.1055\/s-0037-1608933.","journal-title":"J Knee Surg"},{"issue":"11","key":"399_CR7","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1302\/2058-5241.5.200030","volume":"5","author":"AK Prasad","year":"2020","unstructured":"Prasad AK, Tan JHS, Bedair HS, Dawson-Bowling S, Hanna SA. Cemented vs. cementless fixation in primary total knee arthroplasty: a systematic review and meta-analysis. EFORT Open Rev. 2020;5(11):793\u20138. https:\/\/doi.org\/10.1302\/2058-5241.5.200030.","journal-title":"EFORT Open Rev"},{"issue":"3","key":"399_CR8","doi-asserted-by":"publisher","first-page":"121","DOI":"10.11138\/jts\/2013.1.3.121","volume":"1","author":"F Matassi","year":"2013","unstructured":"Matassi F, Carulli C, Civinini R, Innocenti M. Cemented versus cementless fixation in total knee arthroplasty. Joints. 2013;1(3):121\u20135 PMID:25606521.","journal-title":"Joints"},{"key":"399_CR9","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2025.04.076","author":"NR Olson","year":"2025","unstructured":"Olson NR, Parks NL, Nagda SS, McAsey CJ, Fricka KB. To cement or not? Ten-Year results of a prospective, randomized study comparing cemented versus cementless total knee arthroplasty. J Arthroplasty. 2025. https:\/\/doi.org\/10.1016\/j.arth.2025.04.076.","journal-title":"J Arthroplasty"},{"key":"399_CR10","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/j.ijsu.2018.04.015","volume":"53","author":"K Zhou","year":"2018","unstructured":"Zhou K, Yu H, Li J, Wang H, Zhou Z, Pei F. No difference in implant survivorship and clinical outcomes between full-cementless and full-cemented fixation in primary total knee arthroplasty: a systematic review and meta-analysis. Int J Surg. 2018;53:312\u20139. https:\/\/doi.org\/10.1016\/j.ijsu.2018.04.015.","journal-title":"Int J Surg"},{"key":"399_CR11","doi-asserted-by":"publisher","first-page":"133","DOI":"10.2174\/1874325001711010133","volume":"11","author":"E Franceschetti","year":"2017","unstructured":"Franceschetti E, Torre G, Palumbo A, Papalia R, Paciotti M, Maffulli N, et al. No difference between cemented and cementless total knee arthroplasty in young patients: a review of the evidence. Open Orthop J. 2017;11:133\u20138. https:\/\/doi.org\/10.2174\/1874325001711010133.","journal-title":"Open Orthop J"},{"issue":"1","key":"399_CR12","doi-asserted-by":"publisher","first-page":"S45","DOI":"10.1016\/j.arth.2023.08.019","volume":"39","author":"M Yayac","year":"2024","unstructured":"Yayac M, Harrer S, Hozack WJ. Cementless total knee arthroplasty: a resurgence\u2014who, when, and how. J Arthroplasty. 2024;39(1):S45\u201353. https:\/\/doi.org\/10.1016\/j.arth.2023.08.019.","journal-title":"J Arthroplasty"},{"issue":"4","key":"399_CR13","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1016\/j.arth.2017.11.048","volume":"33","author":"AJ Miller","year":"2018","unstructured":"Miller AJ, Stimac JD, Smith LS, Feher AW, Bhimani SJ, Mont MA. Results of cemented vs cementless primary total knee arthroplasty using the same implant design. J Arthroplasty. 2018;33(4):1089\u201393. https:\/\/doi.org\/10.1016\/j.arth.2017.11.048.","journal-title":"J Arthroplasty"},{"issue":"2","key":"399_CR14","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1016\/j.arth.2018.10.016","volume":"34","author":"BJ Sinicrope","year":"2019","unstructured":"Sinicrope BJ, Feher AW, Bhimani SJ, Smith LS, Harwin SF, Yakkanti MR, et al. Increased survivorship of cementless versus cemented TKA in the morbidly obese. A minimum 5-year follow-up. J Arthroplasty. 2019;34(2):309\u201314. https:\/\/doi.org\/10.1016\/j.arth.2018.10.016.","journal-title":"J Arthroplasty"},{"issue":"3","key":"399_CR15","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000018750","volume":"99","author":"K Wang","year":"2020","unstructured":"Wang K, Sun H, Zhang K, Li S, Wu G, Zhou J, et al. Better outcomes are associated with cementless fixation in primary total knee arthroplasty in young patients: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2020;99(3):e18750. https:\/\/doi.org\/10.1097\/MD.0000000000018750.","journal-title":"Medicine (Baltimore)"}],"container-title":["Arthroplasty"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42836-026-00399-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42836-026-00399-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42836-026-00399-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T23:04:08Z","timestamp":1782860648000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s42836-026-00399-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["399"],"URL":"https:\/\/doi.org\/10.1186\/s42836-026-00399-2","relation":{},"ISSN":["2524-7948"],"issn-type":[{"value":"2524-7948","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"assertion":[{"value":"27 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Provincial Research Ethics Committee of M\u00e1laga, Spain (Reference Code CEI-24_2020; SICEIA-2024-001425), and was conducted in accordance with the Declaration of Helsinki. Written informed consent to participate in this study was obtained from all participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"47"}}