Commentary Open Access

Cementless Fixation in Orthopaedics: Evolution, Principles, and Clinical Perspectives

Abstract

Cementless fixation has emerged as a significant advancement in modern joint arthroplasty, offering a biologic alternative to traditional cemented fixation techniques. The concept relies on osseointegration, where bone grows onto or into porous implant surfaces, ensuring long-term biological stability. Initially developed as an alternative to cemented implants in younger and more active patients, cementless fixation has now expanded across hip and knee arthroplasty due to improvements in biomaterials, surface coatings, and implant design. Clinical studies demonstrate comparable survivorship between cementless and cemented implants, particularly in total hip arthroplasty, while its role in total knee arthroplasty continues to evolve. Advantages include preservation of bone stock, reduced risk of cement-related complications, and easier revision surgery. However, challenges such as early micromotion, patient selection, and variability in bone quality remain important considerations. This article reviews the principles, indications, outcomes, advantages, limitations, and future directions of cementless fixation in orthopaedics.

Alexander R. Whitmore

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