Cemented vs. Cementless Fixation Joint Replacement Surgery: A Review for You

Joint replacement surgery—most commonly performed on hips and knees—has transformed the lives of millions by relieving pain, restoring movement, and improving quality of life. As technology advances, surgeons now have choices in how they fixate the prosthesis to the bone. The two primary techniques are cemented fixation and cementless fixation (also called uncemented fixation). Understanding the differences between the two can help the patient and family feel more informed about their care and surgical options.

What Is Fixation in Joint Replacement?

Fixation refers to how the prosthetic components are secured to the bone during joint replacement surgery. Regardless of whether you are undergoing a hip, knee, shoulder, elbow or ankle replacement, the goal is the same: to ensure the implanted joint components remain securely in place for many years.

Why Today’s Joint Replacements Need to Last Longer

Several changes in health and lifestyle are increasing the need for joint replacements that can stand the test of time:

• People are having joint replacements surgery at younger ages.
  Due to better technology and improved surgical techniques, more patients in their 40s and 50s, and sometimes younger, are good candidates for surgery. Younger patients tend to be more active, and the implants need to be strong and long-lasting.
• People are living longer.
  With longer life expectancies, a joint replacement may need to stay reliable for 20–30 years or more, making long-term durability even more important.
• Revision surgeries are harder on the body.
  A second surgery to fix or replace an implant is more complex and requires longer recovery. Because of this, patients and doctors want the first replacement to last as long as possible.
• Patients want to stay active.
  Today’s patients want to maintain active lifestyles—working, exercising, traveling, and enjoying hobbies without limitations. Longer-lasting implants support these goals.

Cemented Fixation

In cemented fixation, a special medical-grade bone cement, polymethylmethacrylate, is used to anchor the prosthesis to the bone. The cement hardens within minutes, forming a strong bond between the implant and the bone. Bone cement functions like a grout by filling the space between a prosthesis and bone, providing stability, and transferring load however, it does not have adhesive properties. The mechanical interlock is between the engineered parts of the prosthesis and the bone surface prepared for implantation. 

Benefits of Cemented Fixation:

• Immediate stability: Because the cement hardens within five to ten minutes, the implant is stable right away, which allows for earlier mobility and rehabilitation. 
• Reliable for weaker bones: This technique is particularly useful for patients with softer or osteoporotic bone, where uncemented fixation might not hold as well.
• Well-studied and time-tested: Cemented fixation has been used for decades, with many studies showing excellent long-term results.

Who Might Benefit from Cemented Fixation?

• Older adults: Particularly whose bones may be less dense or more brittle.
• Patients with osteoporosis: Osteoporosis is a common medical condition concerning weakened bones. The cement fixation provides the support the bone alone may not.
• Medical conditions with impaired bone healing: Since cemented joints do not rely on bone healing for fixation, they are a good fit for people with diagnoses associated with slower bone healing.

Cementless Fixation

Cementless fixation, also known as press-fit fixation, relies on the bone growing into the implant to secure it over time. These implants have a porous or rough surface on the portion that contacts the bone. This encourages natural bone growth into these pores to lock the prosthetic components in place.

Benefits of Cementless Fixation:

• Bone integration: Over time, the bone fuses with the implant, creating a biological bond. This may take six to eight weeks or more. 
• Potentially longer-lasting: In younger, active patients with good bone quality, this natural integration may lead to a longer-lasting joint.
• Capacity to remodel: Since the bone bond is biologic, the bone growth into the prosthesis can remodel, adapt, and strengthen over time. 

Who Might Benefit from Cementless Fixation?

• Younger patients: These individuals typically have denser bone that can support a secure press-fit.
• Active lifestyles: The implant fixation is designed to last longer, which is helpful for people who place more demands on their joints.
• Healthy bone structure: Patients without osteoporosis or other bone-weakening conditions are good candidates.

Making the Right Choice

There’s no one-size-fits-all approach in joint replacement. Surgeons carefully evaluate several factors, including age, activity level, previous trauma, bone cysts, deformity, previous fracture repair surgery, bone quality, and overall health before deciding which fixation method to use. In some cases, a hybrid fixation is used, where part of the joint is cemented and another part is cementless. The choice of fixation in the same patient may also vary depending on the joint location. For example, the best choice in the same patient may be a cementless hip replacement and a cemented knee replacement. This is based on multiple factors that the surgeon reviews for each particular surgery. 

Patients should understand that both techniques have strong records of success. The key is to work closely with your orthopedic surgeon to determine which method aligns best with your joint and lifestyle.

Final Thoughts

Whether cemented or cementless, modern joint replacements are safe, effective, and life changing. By understanding the differences in fixation methods, patients can better participate in their care and recovery. If you or a loved one is considering joint replacement surgery, do not hesitate to ask your doctor which method they recommend—and why.

Your path forward starts with knowledge, collaboration, and a personalized treatment plan.

To learn more about Sanara MedTech products, please visit  Our Surgical Products | Sanara MedTech Inc. .

Medical Disclaimer 

This blog is for informational purposes only and does not constitute medical advice. Content is not intended to diagnose, treat, cure, or prevent any disease and has not been evaluated by the U.S. Food and Drug Administration (FDA). Always consult a licensed healthcare provider before making medical decisions. Use of this blog is at your own risk. 

References: 

1. Matthias J, Bostrom MP, Lane JM. A Comparison of Risks and Benefits Regarding Hip Arthroplasty Fixation. J Am Acad Orthop Surg Glob Res Rev. 2021 Nov 1;5(11):e21.00014. doi: 10.5435/JAAOSGlobal-D-21-00014. PMID: 34726640; PMCID: PMC8565793.

2. Behery OA, Kearns SM, Rabinowitz JM, Levine BR. Cementless vs Cemented Tibial Fixation in Primary Total Knee Arthroplasty. J Arthroplasty. 2017 May;32(5):1510-1515. doi: 10.1016/j.arth.2016.12.023. Epub 2016 Dec 22. PMID: 28082042.