Triathlon Tritanium
Cementless Total Knee System

Why cementless TKA?

Encouraging outcomes for challenging patient demographics

Patient demographics for TKA have become younger and heavier,^1,2 and these patients have demonstrated higher risk of revision in TKAs.^3-5 When biologic fixation is achieved, cementless TKA has the potential for a more durable bone-implant interface that can better withstand the added mechanical stress in obese patients.⁶ In a retrospective study with 193 patients with a minimum of five-year follow-up, morbidly obese (BMI ≥40) patients receiving cementless primary Triathlon TKA with a PS design demonstrated improved survivorship compared to those who received a cemented Triathlon TKA.⁵ Furthermore, the American Joint Replacement Registry reported male patients younger than 65 years adjusted for age receiving a cementless TKA showed a better survivorship than those who received cemented TKA; however the difference is small (<1%) and does not account for other potential confounders.⁷

Potential savings in time and cost

As the volume of TKA procedures continues to increase, the costs associated with this surgical procedure continue to be an important topic. Cementless TKA allows the potential to reduce operating room time^8,9 and save expenses without the use of bone cement and cement accessories.¹⁰ A healthcare economic study in the U.S. concluded that the actual overall cost of cementless TKA could be offset by shortened operating room time and the lack of need for cement and cementing accessories.¹⁰

Strong clinical evidence

Cementless TKA is growing in popularity.⁷ The 2019 National Joint Registry Report in the U.K. supports the long-term outcome of cementless femoral components,¹¹ and the AAOS evidence-based clinical practice guideline found strong evidence suggesting similar functional outcomes between cemented and cementless tibial baseplates.¹² Triathlon Tritanium cementless TKA demonstrated excellent clinical outcomes in multiple studies with five-year follow-up^12,14 and achieved similar functional outcomes as well as pain reduction compared to cemented Triathlon TKA in multiple short- to midterm studies.^8,19

1. Memtsoudis et al. Trends in demographics, comorbidity profiles, in-hospital complications and mortality associated with primary knee arthroplasty. J Arthroplasty. 2009;24(4):518-527
2. Pabinger et al. Utilization rates of knee-arthroplasty in OECD countries. Osteoarthritis and Cartilage 2015; 23: 1664e1673
3. Johnson et al. Patient Demographics as a Predictor of the Ten year Survival Rate in Primary Total Knee Replacement. The Journal of Bone and Joint Surgery 2003 85.1 pp. 5256
4. Schreurs et al. Total Joint Arthroplasty in Younger Patients: Heading for Trouble? The Lancet (2017), volume 389, Issue 10077, P1374-1375.
5. Abdel et al. Increased aseptic tibial failures in patients with a BMI 35 and well-aligned total knee arthroplasties. J Arthroplasty 2015;30:2181e4.
6. Sinicrope et al. Increased survivorship of cementless versus cemented TKA in the morbidly obese. a minimum 5-year follow-up. J Arthroplasty. 2019;34(2):309-314
7. American Joint Replacement Registry (AJRR): 2019 Annual Report. Rosemont, IL: American Academy of Orthopaedic Surgeons (AAOS), 2019
8. Nam D., et al. Perioperative and Early Postoperative Comparison of a Modern Cemented and Cementless Total Knee Arthroplasty of the Same Design. The Journal of Arthroplasty 32 (2017) 2151-2155
9. Cohen et al.  Early clinical outcomes of a new cementless total knee arthroplasty design. Orthopedics. 2018;41(6):e765-e771.
10. Yayac et al.  The use of cementless components does not significantly increase procedural costs in total knee arthroplasty. J Arthroplasty. 2020;35(2): 407-412.
11. National Joint Registry for England, Wales and Northern Ireland and Isle of Man. 16th Annual Report. 2019.
12. American Academy of Orthopaedic Surgeons (AAOS). Surgical management of osteoarthritis of the knee. Evidence-based clinical practice guideline. 2015;https://www.aaos.org/globalassets/quality-and-practice-resources/surgical-management-knee/smoak-cpg_4.22.2016.pdf
13. Tarazi et al.  Mont MA, Harwin SF. Cementless Tritanium Baseplate total knee arthroplasty: survivorship and outcomes at 5-year minimum follow-up. J Knee Surg. Accepted manuscript. Published online June 19, 2020. 
14. Silverstein et al.  5 year follow up data for cementless total knee arthroplasty patients. Poster presented at: Orthopaedic Research Society (ORS) 2020 Annual Meeting; February 8-11, 2020; Phoenix, AZ.
15. Harwin et al. Outcomes of cementless-backed patellar components. J Knee Surg. Accepted manuscript. Published online May 29, 2020.
16. Harwin et al. Outcomes of newer generation cementless total knee arthroplasty: beaded periapatite-coated vs highly porous titanium-coated implants. J Arthroplasty. 2017;32(7):2156-2160.
17. Bhowmik-Stoker et al. Clinical performance of a novel 3D printed cementless titanium tibial baseplate, 2-4 year follow-up. Presented at: 2nd World Arthroplasty Congress; April 19-21, 2018. Rome, Italy. 
18. Masini et al.  Cementless total knee arthroplasty resulting in no revisions due to tibial component loosening and improved outcomes. Presented at: American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting. March 24-28, 2018. Orlando, FL.
19. Miller et al.  Results of cemented vs cementless primary total knee arthroplasty using the same implant design. J Arthroplasty. 2018;33(4):1089-1093.