Primary Knee| Volume 38, ISSUE 1, P85-89, January 2023

Mid-Term Performance of the First Mass-Produced Three-Dimensional Printed Cementless Tibia in the United States as Reported in the American Joint Replacement Registry

Published:August 04, 2022DOI:



      Cementless tibial components have shown improvements in clinical performance compared to predicate designs, though evidence supporting mid-term performance and fixation is scarce. The purpose of this study is to determine the mid-term survivorships, revision rates, and reasons why 3-dimensional printed cementless tibial baseplates (3DTKAs) failed compared to other cementless as well as cemented tibial baseplates reported from the American Joint Replacement Registry (AJRR) data.


      All primary total knee arthroplasty (TKA) cases performed in patients 65 years of age or older within the AJRR from January 2, 2012 through June 30, 2020 were queried. A total of 28,631 3DTKAs were identified from 428 institutions. These were compared to all other “aggregated cementless tibia” (n = 7,577) and “aggregated cemented tibia” (n = 550,133) cases. Centers for Medicare & Medicaid Services data over the same time period were merged with AJRR data to determine survivorship and patient-timed incident revision rates per 1,000 years. Failure reasons were tracked during this study period.


      At 60 months, Kaplan-Meier implant survivorship was 98.9% (CI 98.7-99.0), 98.3% (CI 97.9-98.6), and 98.4% (CI 98.4-98.5) in the 3DTKA, aggregate cementless, and cemented knee cohorts, respectively (P < .0001). Patient-timed incident revision rates were 3.11 (CI 2.75-3.53), 3.99 (CI 3.34-4.76), and 3.35 (CI 3.28-3.42) for those cohorts, which corresponds to a revision rate of 0.31%, 0.40%, and 0.34% per year.


      In this analysis, 3DTKA had favorable survivorship and lower revision rates compared to aggregate cementless and cemented TKAs implanted from the same national database during the same time period.


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        • Duffy G.P.
        • Murray B.E.
        • Trousdale R.R.
        Hybrid total knee arthroplasty. Analysis of component failures at an average of 15 years.
        J Arthroplasty. 2007; 22: 1112-1115
        • Gold P.A.
        • Garbarino L.
        • Sodhi N.
        • Barrack R.
        • Springer B.D.
        • Mont M.A.
        The case for cementless total knee arthroplasty.
        Surg Technol Int. 2020; 36: 388-396
        • Mont M.A.
        • Pivec R.
        • Issa K.
        • Kapadia B.H.
        • Maheshwari A.
        • Harwin S.F.
        Long-term implant survivorship of cementless total knee arthroplasty: a systematic review of the literature and meta-analysis.
        J Knee Surg. 2014; 27: 369-376
        • Meneghini R.M.
        • Hanssen A.D.
        Cementless fixation in total knee arthroplasty past, present, and future.
        J Knee Surg. 2008; 21: 307-314
        • Harwin S.F.
        • Patel N.K.
        • Chughtai M.
        • Khlopas A.
        • Ramkumar P.N.
        • Roche M.
        • et al.
        Outcomes of newer generation cementless total knee arthroplasty: beaded periapatite-coated vs highly porous titanium-coated implants.
        J Arthroplasty. 2017; 32: 2156-2160
        • Pulido L.
        • Abdel M.P.
        • Lewallen D.G.
        • Stuart M.J.
        • Sanchez-Sotelo J.
        • Hanssen A.D.
        • et al.
        The mark coventry award: trabecular metal tibial components were durable and reliable in primary total knee arthroplasty: a randomized clinical trial.
        Clin Orthop Relat Res. 2015; 474: 34-42
        • Sporer S.
        • MacLean L.
        • Burger A.
        • Moric M.
        Evaluation of a 3D-printed total knee arthroplasty using radiostereometric analysis: assessment of highly porous biological fixation of the tibial baseplate and metal-backed patellar component.
        Bone Joint J. 2019; 101B: 40-47
        • Hasan S.
        • Hamersveld K.T.V.
        • Mheen P.J.M.
        • Vande Kaptein B.L.
        • Nelissen R.G.H.H.
        • Toksvig-Larsen S.
        Migration of a novel 3D-printed cementless versus a cemented total knee arthroplasty: two-year results of a randomized controlled trial using radiostereometric analysis.
        Bone Joint J. 2020; 102: 1016-1024
        • Nam D.
        • Kopinski J.E.
        • Meyer Z.
        • Rames R.D.
        • Nunley R.M.
        • Barrack R.L.
        Perioperative and early postoperative comparison of a modern cemented and cementless total knee arthroplasty of the same design.
        J Arthroplasty. 2017; 32: 2151-2155
        • Cohen R.G.
        • Sherman N.C.
        • James S.L.
        Early clinical outcomes of a new cementless total knee arthroplasty design.
        Orthopedics. 2018; 41: e765-e771
        • Tarazi J.M.
        • Salem H.S.
        • Ehiorobo J.O.
        • Sodhi N.
        • Mont M.A.
        • Harwin S.F.
        Cementless tritanium baseplate total knee arthroplasty: survivorship and outcomes at 5-year minimum follow-up.
        J Knee Surg. 2020; 33: 862-865
        • Sultan A.A.
        • Khlopas A.
        • Sodhi N.
        • Denzine M.L.
        • Ramkumar P.N.
        • Harwin S.F.
        • et al.
        Cementless total knee arthroplasty in knee osteonecrosis demonstrated excellent survivorship and outcomes at three-year minimum follow-up.
        J Arthroplasty. 2018; 33: 761-765
        • Bagsby D.T.
        • Issa K.
        • Smith L.S.
        • Elmallah R.K.
        • Mast L.E.
        • Harwin S.F.
        • et al.
        Cemented vs cementless total knee arthroplasty in morbidly obese patients.
        J Arthroplasty. 2016; 31: 1727-1731
        • Nam D.
        • Lawrie C.M.
        • Salih R.
        • Nahhas C.R.
        • Barrack R.L.
        • Nunley R.M.
        Cemented versus cementless total knee arthroplasty of the same modern design: a prospective, randomized trial.
        J Bone Joint Surg Am. 2019; 101: 1185-1192
      1. American joint replacement registry annual report 2020.

        • Kaplan E.L.
        • Meier P.
        Nonparametric estimation from incomplete observations.
        J Am Stat Assoc. 1958; 53: 457-481
        • Behery O.A.
        • Kearns S.M.
        • Rabinowitz J.M.
        • Levine B.R.
        Cementless vs cemented tibial fixation in primary total knee arthroplasty.
        J Arthroplasty. 2017; 32: 1510-1515
        • Bhimji S.
        • Meneghini R.M.
        Micromotion of cementless tibial baseplates: keels with adjuvant pegs offer more stability than pegs alone.
        J Arthroplasty. 2014; 29: 1503-1506
        • Schmidt W.
        • LiArno S.
        • Khlopas A.
        • Petersik A.
        • Mont M.A.
        Stryker orthopaedic modeling and Analytics (SOMA): a review.
        Surg Technol Int. 2018; 32: 315-324
        • Banerjee S.
        • D’Alessio J.
        • Kester M.
        • Harwin S.F.
        • Dunbar M.
        • Mont M.A.
        Innovations in knee arthroplasty: three-dimensional modeling and analytical technology (SOMA).
        Surg Technol Int. 2014; 24: 288-294
        • 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.
        Med (United States). 2020; 99: e18750
        • Chen C.
        • Li R.
        Cementless versus cemented total knee arthroplasty in young patients: a meta-analysis of randomized controlled trials.
        J Orthop Surg Res. 2019; 14: 262
        • Bingham J.S.
        • Salib C.G.
        • Hanssen A.D.
        • Taunton M.J.
        • Pagnano M.W.
        • Abdel M.P.
        Clinical outcomes and survivorship of contemporary cementless primary total knee arthroplasties.
        JBJS Rev. 2020; 8: e2000026
        • Porter K.R.
        • Illgen R.L.
        • Springer B.D.
        • Bozic K.J.
        • Sporer S.M.
        • Huddleston J.I.
        • et al.
        Is American joint replacement registry data representative of national data? A comparative analysis.
        J Am Acad Orthop Surg. 2021; 30: e124-e130