{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:04:35Z","timestamp":1789049075714,"version":"build-2803163510"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>With the increasing adoption of both cementless fixation and robotic-assisted techniques in total knee arthroplasty (TKA), it is important to recognize that these approaches carry distinct historical concerns. Earlier generations of cementless implants were associated with higher early failure rates due to inadequate osseointegration, while early robotic systems faced criticism for increased operative times and complication risk. As a result, the current literature presents conflicting evidence regarding the impact of these technologies on early complications and revision rates. This study compares the reoperation rates across 4 TKA cohorts, cemented vs. cementless, with and without robotic assistance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A retrospective cohort study was conducted using a national administrative claims database. Primary TKA cases were identified using International Classification of Diseases, 10th Revision, and Current Procedural Terminology codes, and 4 cohorts were created: robotic-cemented (R-CEMENT), robotic-cementless (R-CEMENTLESS), conventional-cemented (C-CEMENT), and conventional-cementless (C-CEMENTLESS). Matching was performed based on age, sex, Elixhauser Comorbidity Index, obesity, tobacco use, and diabetes, resulting in 5,210 patients in each group. Outcomes assessed included 1-, 5-, and 10-year ipsilateral reoperations, 30-day emergency department utilizations, and 10-year failure-free survival. \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      tests were used for group comparisons, with p &lt; 0.05 indicating significance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In the matched cohort (n = 20,840, C-CEMENTLESS, C-CEMENT, R-CEMENTLESS, R-CEMENT; n = 5,210 each), 1-year reoperation rates were lowest in C-CEMENTLESS (0.44%) and R-CEMENTLESS (0.52%), followed by R-CEMENT (0.84%) and C-CEMENT (0.92%) (p = 0.005). At 5 and 10 years, reoperation rates remained lowest in C-CEMENTLESS (0.79%) and R-CEMENTLESS (1.02%), compared with higher rates in C-CEMENT (1.86%) and R-CEMENT (1.71%) (p &lt; 0.001). Kaplan\u2013Meier survival showed 99.7% 5-year survivorship in C-CEMENTLESS and R-CEMENTLESS, versus 99.5% in both cemented groups (p-value &lt; 0.05). No significant differences were observed in 30-day ED utilization (p = 0.11) or readmissions (p = 0.75) across all 4 matched cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Cementless fixation in TKA, whether robotic or conventional, demonstrated comparable short-term reoperation rates and equivalent long-term survivorship to cemented fixation. Robotic assistance did not significantly affect failure-free survival or healthcare utilization. All 4 cohorts showed excellent 10-year outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.26.00043","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T19:00:08Z","timestamp":1778094008000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Robotic Assistance and Fixation Type on Revisions, Complications, and Survivorship Following Total Knee Arthroplasty"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1643-0828","authenticated-orcid":false,"given":"Hania","family":"Shahzad","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, UC Davis Health, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0088-3173","authenticated-orcid":false,"given":"Mandeep S.","family":"Chhokar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahej Deep","family":"Singh Randhawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, UC Davis Health, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3752-4719","authenticated-orcid":false,"given":"John P.","family":"Meehan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, UC Davis Health, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7518-3361","authenticated-orcid":false,"given":"Mauro","family":"Giordani","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, UC Davis Health, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7736-795X","authenticated-orcid":false,"given":"Adam J.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, UC Davis Health, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5871-8539","authenticated-orcid":false,"given":"Zachary C.","family":"Lum","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, UC Davis Health, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4]]},"reference":[{"issue":"1","key":"R1-20260506","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1302\/0301-620X.85B1.12992","article-title":"Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement","volume":"85-B","author":"Johnson","year":"2003","journal-title":"J Bone Jt Surg Br"},{"issue":"1","key":"R2-20260506","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S0883-5403(97)90046-2","article-title":"5- to 18-year follow-up study of cemented total knee arthroplasty for patients 55 years old or younger","volume":"12","author":"Gill","year":"1997","journal-title":"J Arthroplasty"},{"issue":"2","key":"R3-20260506","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S0968-0160(01)00146-6","article-title":"Ten to fourteen year survival and functional analysis of the AGC total knee replacement system","volume":"9","author":"Worland","year":"2002","journal-title":"Knee"},{"issue":"04","key":"R4-20260506","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1055\/s-0030-1247837","article-title":"Cementless fixation in total knee arthroplasty: past, present, and future","volume":"21","author":"Meneghini","year":"2008","journal-title":"J Knee Surg."},{"issue":"22","key":"R5-20260506","doi-asserted-by":"crossref","first-page":"6608","DOI":"10.3390\/jcm11226608","article-title":"The evolution, current indications and outcomes of cementless total knee arthroplasty","volume":"11","author":"Schwabe","year":"2022","journal-title":"J Clin Med."},{"issue":"09","key":"R6-20260506","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1055\/s-0040-1708880","article-title":"Cementless fixation for total knee arthroplasty in various patient populations: a literature review","volume":"33","author":"Salem","year":"2020","journal-title":"J Knee Surg."},{"issue":"7","key":"R7-20260506","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1302\/0301-620X.98B7.37367","article-title":"Cementless total knee arthroplasty: current concepts review","volume":"98-B","author":"Dalury","year":"2016","journal-title":"Bone Jt J."},{"issue":"9","key":"R8-20260506","doi-asserted-by":"crossref","first-page":"S45","DOI":"10.1016\/j.arth.2024.02.078","article-title":"Cementless total knee arthroplasty: a resurgence\u2014who, when, where, and how?","volume":"39","author":"Mosher","year":"2024","journal-title":"J Arthroplasty"},{"issue":"12","key":"R9-20260506","doi-asserted-by":"crossref","first-page":"3474","DOI":"10.1016\/j.arth.2020.06.072","article-title":"Robotic surgery in total joint arthroplasty: a survey of the AAHKS membership to understand the utilization, motivations, and perceptions of total joint surgeons","volume":"35","author":"Sherman","year":"2020","journal-title":"J Arthroplasty"},{"key":"R10-20260506","doi-asserted-by":"crossref","first-page":"101360","DOI":"10.1016\/j.artd.2024.101360","article-title":"Cemented vs cementless robotic-assisted total knee arthroplasty yield similar short-term clinical outcomes","volume":"27","author":"Molho","year":"2024","journal-title":"Arthroplasty Today"},{"key":"R11-20260506","doi-asserted-by":"crossref","first-page":"101122","DOI":"10.1016\/j.artd.2023.101122","article-title":"Cementless compared to cemented total knee arthroplasty is associated with more revisions within 1 year of index surgery","volume":"21","author":"Chiou","year":"2023","journal-title":"Arthroplasty Today"},{"issue":"1","key":"R12-20260506","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s11701-025-02313-5","article-title":"Trends of robotic total joint arthroplasty utilization in the United States from 2010 to 2022: a nationwide assessment","volume":"19","author":"Gordon","year":"2025","journal-title":"J Robotic Surg."},{"key":"R13-20260506","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1016\/j.wneu.2020.01.141","article-title":"Elixhauser comorbidity measure is superior to charlson comorbidity index In-Predicting hospital complications following elective posterior cervical decompression and fusion","volume":"138","author":"Maron","year":"2020","journal-title":"World Neurosurg."},{"issue":"18","key":"R14-20260506","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.2106\/JBJS.23.00161","article-title":"Cementless versus cemented total knee arthroplasty: concise midterm results of a prospective randomized controlled trial","volume":"105","author":"Hannon","year":"2023","journal-title":"J Bone Jt Surg."},{"issue":"6","key":"R15-20260506","doi-asserted-by":"crossref","first-page":"2899","DOI":"10.1007\/s11701-023-01703-x","article-title":"Systematic review and meta-analysis of economic and healthcare resource utilization outcomes for robotic versus manual total knee arthroplasty","volume":"17","author":"Hoeffel","year":"2023","journal-title":"J Robotic Surg."},{"issue":"10","key":"R16-20260506","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1302\/2058-5241.4.190022","article-title":"Robotic technology in total knee arthroplasty: a systematic review","volume":"4","author":"Kayani","year":"2019","journal-title":"EFORT Open Rev."}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.26.00043","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:30:05Z","timestamp":1787751005000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.26.00043"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.26.00043","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}