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All topics
  1. What it is
  2. Who it helps
  3. Timing
  4. The procedure
  5. Patient journey
  6. Recovery supplies
  7. Implant designs
  8. Side-by-side
  9. Robotics and alignment
  10. US manufacturers
  11. What the evidence says
  12. Value analysis
  13. Questions to ask
  14. Resources
  15. Glossary
  16. References

Summary

Side by side

A simplified view of the main choices. Each row is a general finding, not a guarantee for any individual patient.

ChoiceOptionsWhat the evidence shows
FixationCemented vs cementlessNo difference in RCTs; registries show no cementless advantage, with higher early revision for some designs14,15,16
LigamentsCruciate-retaining vs posterior-stabilizedDifferences too small to matter clinically18
BearingFixed vs mobileNo difference across 74 RCTs19
KneecapResurface vs retainLess front-knee pain and reoperation with resurfacing in one analysis; overall unsettled20,21
TechnologyRobotic vs conventionalFewer alignment outliers; RCTs show no clear functional benefit22,23
AlignmentKinematic vs mechanicalSimilar outcomes in RCT meta-analyses24,25
ExtentPartial vs total (one-compartment arthritis)Similar function, partial cheaper, but higher revision rate26,27
SettingSame-day vs inpatientSimilar complications and readmissions in selected patients28

Sources for this page

  1. Prasad AK, et al. Cemented vs. cementless fixation in primary total knee arthroplasty: a systematic review and meta-analysis. EFORT Open Rev. 2020;5(11):793-798. doi:10.1302/2058-5241.5.200030
  2. Paull TZ, et al. Uncemented total knee arthroplasty in the State of Michigan has higher rates of revision through 5-year follow-up. J Arthroplasty. 2025;40(7S1):S263-S270. doi:10.1016/j.arth.2025.03.007
  3. Chen F, et al. What is the survivorship of TKA with a twin-peg or spikes-and-keel cementless implant compared with cemented? A registry-based cohort study. Clin Orthop Relat Res. 2025;483(7):1288-1298. doi:10.1097/CORR.0000000000003385
  4. Verra WC, et al. Retention versus sacrifice of the posterior cruciate ligament in total knee arthroplasty for treating osteoarthritis. Cochrane Database Syst Rev. 2013;(10):CD004803. doi:10.1002/14651858.CD004803.pub3
  5. Migliorini F, et al. No difference between mobile and fixed bearing in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022;30(9):3138-3154. doi:10.1007/s00167-022-07065-5
  6. Simpson CJRW, et al. Patellar resurfacing versus retention in cruciate-retaining and posterior-stabilized total knee arthroplasty. Bone Joint J. 2023;105-B(6):622-634. doi:10.1302/0301-620X.105B6.BJJ-2022-0970.R2
  7. Grassi A, et al. Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses. Knee Surg Sports Traumatol Arthrosc. 2018;26(11):3206-3218. doi:10.1007/s00167-018-4831-8
  8. Abdelaziz O, et al. Comparative pain relief and functional outcomes following robotic-assisted versus conventional total knee arthroplasty: a GRADE-assessed meta-analysis with meta-regression of randomized controlled trials. J Robot Surg. 2026;20(1). doi:10.1007/s11701-026-03934-0
  9. Onggo JR, et al. Robotic-assisted total knee arthroplasty is comparable to conventional total knee arthroplasty: a meta-analysis and systematic review. Arch Orthop Trauma Surg. 2020;140(10):1533-1549. doi:10.1007/s00402-020-03512-5
  10. Blackman BW, et al. Kinematic and mechanical alignment yield similar outcomes in total knee arthroplasty: a systematic review and a meta-analysis of randomized controlled trials. J Arthroplasty. 2026;41(10):3188-3198.e1. doi:10.1016/j.arth.2026.01.036
  11. Gusho C, et al. No superiority of total knee arthroplasty alignment philosophies: a network meta-analysis comparing mechanical, anatomical, kinematic, restricted kinematic, and functional alignment among randomized controlled trials. JBJS Rev. 2025;13(8):e25.00101. doi:10.2106/JBJS.RVW.25.00101
  12. Beard DJ, et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet. 2019;394(10200):746-756. doi:10.1016/S0140-6736(19)31281-4
  13. Wilson HA, et al. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ. 2019;364:l352. doi:10.1136/bmj.l352
  14. Bemelmans YFL, et al. Safety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis. Arch Orthop Trauma Surg. 2022;142(8):1775-1791. doi:10.1007/s00402-021-03811-5

All references