Knee Replacement Implant Design Selection

Implant Design Variations

The American Academy of Orthopaedic Surgeons provides strong evidence that there is no clinically meaningful difference between major implant design variations in total knee arthroplasty—cemented versus uncemented fixation, all-polyethylene versus modular tibial components, and posterior-stabilized versus cruciate-retaining designs all produce equivalent outcomes, complications, and revision rates 1, 2

Strong evidence supports using either cemented or uncemented tibial component fixation with similar long-term survivorship 1
Moderate evidence confirms equivalent outcomes when comparing all-cemented versus all-uncemented femoral and tibial components 1, 2

No difference exists in pain, function, or revision rates between all-polyethylene and modular tibial component designs 1

Pain and functional outcomes are equivalent whether the patella is resurfaced or not 1
Patellar resurfacing may reduce the need for revision surgery beyond 5 years postoperatively 1

Strong evidence shows no difference in outcomes or complications with intraoperative navigation compared to conventional instrumentation 1, 3
Patient-specific instrumentation provides no benefit in pain, function, or alignment over conventional techniques 1, 2
Robotic systems increase operative time without improving long-term clinical outcomes or survivorship 3

Strong evidence supports that obese patients have less improvement in outcomes with TKA, requiring preoperative counseling about realistic expectations 1
Moderate evidence shows patients with diabetes are at higher risk for complications 1
Moderate evidence indicates patients with chronic pain conditions have less improvement in patient-reported outcomes 1
Limited evidence suggests patients with depression/anxiety symptoms experience less improvement in outcomes 1