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Clinical outcomes and survivorship of cementless triathlon total knee arthroplasties: a systematic review



Over the last decade, cementless total knee arthroplasty has demonstrated improved outcomes and survivorship due to advances in technologies of implant design, manufacturing capabilities, and biomaterials. Due to increasing interest in cementless implant design for TKA, our aim was to perform a systematic review of the literature to evaluate the clinical outcomes and revision rates of the Triathlon Total Knee system over the past decade.


A systematic review of the literature was conducted following PRISMA guidelines for patients who underwent total knee arthroplasty with cementless Triathalon Total Knee System implants. Patients had a minimum of two-year follow-up and data included clinical outcome scores and survivorship data.


Twenty studies were included in the final analysis. The survivability of the Stryker Triathlon TKA due to all causes was 98.7%, with an aseptic survivability of 99.2%. The overall revision incidence per 1,000 person-years was 3.4. Re-revision incidence per 1,000 person-years was 2.2 for infection, and 1.3 for aseptic loosening. The average KSS for pain was 92.2 and the average KSS for function was 82.7.


This systematic review demonstrated excellent clinical outcomes and survivorship at a mean time of 3.8 years. Additional research is necessary to examine the long-term success of the Stryker Triathlon TKA and the use of cementless TKAs in obese and younger populations.

Level of evidence



Total knee arthroplasty (TKA) is an effective treatment for patients with advanced arthritis of the knee and has yielded excellent results, including long-term survivorship, improved quality of life and pain relief [1,2,3,4]. Currently, there are two methods to achieve implant fixation in TKA: cemented and cementless. The cemented TKA has a long track record, and has become the gold standard but is associated with increased rates of revision and complications in both obese and young populations [5, 6]. According to registry data of 22,298 TKAs, implant revisions increased with an increasing BMI. There was a 3% increased risk of any reoperation for each unit increase in BMI, with that number jumping to 5% per unit increase when BMI was above 30 kg/m2 [2, 7]. A study involving 32,000 TKAs from a Finnish Arthroplasty Register showed an overall aseptic survival rate of 92% in patients younger than 55, compared to a rate of 97% in patients older than 65 [8]. It is estimated that by 2030 the projected amount of TKA performed in the United States will be approximately 3.5 million per year [9]. TKAs are also being performed in younger and more physically active patients [10]. With this in mind, interest has been mounting in cementless TKA designs that will yield positive results in these populations while maintaining a low revision rate at the same time [11, 12].

Proponents of cementless fixation argue that it has the potential for prolonged survival due to the possibility of osteointegration and long term fixation [13,14,15]. Although earlier studies on cementless fixation showed higher rates of aseptic loosening and revisions [16,17,18,19], recent studies have exhibited improved outcomes and survivorship due to advances in technologies of implant design, manufacturing capabilities, and biomaterials [20,21,22,23,24,25,26].

The goal of cementless TKA is to attain biological fixation between the bone and porous implant [27]. Within the last decade, several designs have been implemented in cementless TKA to better achieve this osteointegration. Changes in various components of the implant range from the type of coating used, alterations of the pegs used to secure the baseplate to the tibia, and additive manufacturing of new porous materials. One of such variations of the cementless TKA implant is the Triathlon Total Knee System (Stryker Orthopaedics, Mahwah, New Jersey). This implant design achieves fixation by coating the cobalt-chromium beads of the femoral implant with a manufactured form of hydroxyapatite known as Peri-Apatite, which has been shown to decrease implant migration (Fig. 1) [21, 28]. Three-dimensional printing and additive manufacturing techniques are also employed to create a tibial base plate. Due to increasing interest in cementless implant design for TKA we sought to perform a systematic review of the literature to evaluate the clinical outcomes and revision rates of the Triathlon Total Knee system over the past decade. This system is one of the more popular cementless TKA designs and by focusing on one implant design variability in survivorship among different brands can be eliminated. Our objective was to perform a systematic review of the literature to evaluate the clinical outcomes and revision rates of the Triathlon Total Knee system over the past decade.

Fig. 1
figure 1

Triathalon cementless femoral component


A systematic search of PubMed and MEDLINE was conducted for English language articles published from 2005 to 2021. A combination of the terms “total knee arthroplasty”, “cementless”, “uncemented”, “non-cemented”, “clinical outcomes”, “clinical scores”, and “survivorship” were used as keywords in connection with AND or OR. Level 1 to 4 studies were included in the search. The reference list of the resulting articles was reviewed for inclusion. Each database was last searched in August 2021. Search results were exported and uploaded into a shared file and two authors (BC, AG) independently reviewed each citation and voted for it to be included or excluded from the review. If the votes were split the article would be evaluated by a third author for potential inclusion in the study.

Inclusion criteria included: (1) studies published in English, (2) age and sex of all patients reported, (3) human studies, (4) mean follow-up time longer than or equal to two years, (6) availability of clinical outcome scores, implant details and survivorship data, (7) indication of which implants components were cementless, respective outcome data, and (9) use of Triathlon Total Knee System implants.

Exclusion criteria included: (1) non-clinical studies, (2) exclusively radiostereometric analysis (RSA) studies with follow-up of less than two years, or studies that did not differentiate outcome data if multiple implant types or fixation techniques were used. Each study was evaluated in terms of methodology, patient population, and completeness of datasets. Risk of bias was addressed through assessing random sequence generation, patient selection, attrition, and selective reporting for each citation.

The initial search yielded 583 citations (Fig. 2). After removal of duplicates and a review of all article titles and abstracts, a total of 88 studies were included for full-text review. After excluding studies based on follow-up time, implant brand, and inadequate outcomes, 20 studies remained for the final analysis [11, 20, 21, 29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46] (Table 1).

Fig. 2
figure 2

Flowchart showing the search strategy for study identification

Table 1 Studies included in the systematic review for analysis

The data were collected after a review of the study design, the number of patients, and the risk of bias within each study. Of the included studies, 3 were randomized controlled trials [21, 40, 45], 3 were prospective non-randomized studies [34, 36, 44], 1 was a retrospective comparative study [42], 6 were retrospective case series [29,30,31,32, 37, 38], and 7 were case-control studies [11, 33, 35, 40, 41, 43]. The following data were collected from each study: the number of TKAs and implant design used for cementless fixation, including hybrid designs with individual component fixation data, mean age and follow-up of patients, sex distribution, implant survivorship, reasons for revision, complications, and clinical outcome scores. The results from the individual studies were combined for the analysis. Poisson regression analysis was used to determine the P-values for the incidence rates per 1,000 person-years for revisions. Cemented TKAs, Hybrid constructs and revision TKAs were excluded in the final analysis.


The 20 studies included a total of 5,112 TKAs performed on 4,873 patients (Table 2). Of the 17 studies that included preoperative diagnosis, 4,026 (78.8%) were performed because of worsening osteoarthritis, 392 (7.6%) were performed because of rheumatoid arthritis, 83 (1.6%) were performed because of knee osteonecrosis, and 611 (20%) were done for an unknown reason. The mean age at the time of surgery was 64 years (32–91) and the mean body mass index (BMI) was 33.4 kg/m2 (14 kg/m2–66 kg/m2). The mean follow-up time was 3.8 years (45.5 months) with the longest time being 8 years and the shortest 1.4 years. There were 1,838 male patients (37.7%).

Table 2 Clinical characteristics for Stryker Triathlon cementless TKA fixation

There were a total of 68 (1.33%) revisions from all 20 studies (5,112 TKAs), with 43 (0.8%) done due to aseptic loosening and 25 (0.5%) performed due to septic failure. The survivability of the Stryker Triathlon TKA due to all causes was 98.7% with an aseptic survivability of 99.2%. The overall revision incidence per 1,000 person-years was 3.4. Re-revision incidence per 1,000 person-years was 2.2 for infection, and 1.3 for aseptic loosening. There were 61 documented complications after surgery with the most common complications being a deep vein thrombosis (18), followed by pulmonary embolism (15), postoperative stiffness MUA (9), and superficial wound necrosis (6). The overall complication rate was 1.8%.

There were a total of eight patella revisions to cemented components across the 20 studies included in this review. One patella was dislodged during manipulation under anesthesia and was replaced with a cemented component [29]. In another study, a patient had a traumatic patellar injury but was treated non-surgically and did not need revision [32]. Three studies did not resurface the patella during surgery [21, 40, 45]. Other studies used a combination of cemented and cementless patellar components and resurfacing was done at the discretion of the operating surgeon [11, 40, 42,43,44].

There were only two femoral component revisions across all 20 studies. One was a femoral patellar revision and the other was an all-component revision [44]. All other revisions referenced in this study were of the tibial component.

There was a broad range of data related to outcome measures in the studies included. Nineteen of the twenty studies included patient-recorded outcome measures (PROMs). Sixteen of the twenty studies collected Knee Society Scores (KSS) for pain and 15 studies collected Knee Society Scores for Function postoperatively from their patients (Table 3). The average KSS for pain was 92.2 (100) and the average KSS for function was 82.7 (100). One study [43] used the Lower Extremity Activity Scale (LEAS). Three studies collected Forgotten Joint Scores (FJS-12) [20, 43, 45], with an average score of 61.1 (100). Three studies collected Oxford Knee Scores [20, 33, 40], with an average score of 42 (48). One study [44] used the Knee Injury and Osteoarthritis Outcome for Joint Replacement (KOOS JR) score, reporting a postoperative score of 84.12 (100). Another two studies [21, 45] used KOOS and its five subscales to quantify function in addition to KSS. Two studies collected 12-item Short Form Survey (SF-12) data, with the postoperative average physical health score being 48.7 (US Average = 50). One study [35] did not collect postoperative functional outcome scores.

Table 3 Stryker triathlon cementless TKA functional outcomes, complications, and revision rates


For decades cemented TKAs have been widely accepted as the gold standard for total knee replacements [47]. Recent advancements in additive manufacturing and designs of implants, which used to be too complicated to mass produce, have led to to change in opinions on the viability of cementless TKAs. This study was conducted to investigate the clinical outcomes of one specific newer-generation cementless design, the Stryker Triathlon cementless TKA implant (Fig. 3). Mounting evidence supports the newer cementless components as a viable alternative to cemented implants and may theoretically have advantages in the long run. Bagsby et al. [11] found better PROMs and a lower revision rate when examining the morbidly obese patient undergoing TKAs with a mean follow-up time 3.6 years. Sinicrope et al. [35] found that morbidly obese patients had a higher rate of operative failure due to aseptic loosening with a cemented TKA and decreasing survivorship over time. However, Boyle et al. [43] found that there were no differences in the outcomes between cement and cementless fixations in obese patients undergoing TKA for end-stage osteoarthritis. Patel et al. [38] found a 99.2% survivorship with mean follow-up in cementless TKA in patients with rheumatoid arthritis and showed no obvious contraindications for cementless TKA use in this population. Failure rates have also been shown to be higher using cemented fixation in younger (< 55 year old) patients due to loosening around the bone cement implant interface, which may be improved by utilizing a cementless implant (Fig. 4) [12, 48].

Fig. 3
figure 3

Triathlon cementless implant

Fig. 4
figure 4

Sunrise, anteroposterior and lateral view of bone prosthetic interface

Hasan et al. [45] found that there was no difference in mean maximum total point motion measured via radiostereometric analysis between cemented and cementless TKA after the first three postoperative months. Although the cementless implants migrate more in the initial period after insertion, which might be attributed to settling of the implant, there were no long-term differences [21]. Multiple studies by Harwin et al. [29, 34, 36, 39] have shown excellent outcomes using the cementless Stryker Triathlon in an up to 9-year follow-up, with an all-cause survivorship rate of 98% [36].

In the 20 studies, involving 5,112 Stryker Triathlon TKAs were evaluated. The overall survival rate was 98.7% for the cementless tibial components at the time of final follow-up. There were only two documented failures of the femoral component and eight patellar component failures, both achieving a survival rate over 99.2%.

This study has certain limitations. Most studies included only had mid-term follow-up data, with an average follow-up time of 3.8 years. However, with the cementless design, osteointegration failure is an early complication and might occur prior to the mean follow-up. Not all studies reported the same PROMs data, and one study included no functional outcomes. Furthermore, not all studies reported complications after surgery so the number of complications reported in this review might underestimate the true complication rate. Despite these limitations, the cementless Stryker Triathlon TKA had excellent outcome scores.

The average BMI of the studies in this review was 33.4 kg/m2. This high BMI was due to an average BMI of around 30 kg/m2 in almost every study, which was slightly over the average BMI in the United States. Two studies looked into the outcomes of cementless TKA in a morbidly obese population whose average BMI was over 44 kg/m2 [11, 35].


This study demonstrated excellent clinical outcomes of a single cementless implant at a mean time of 3.8 years. While these results are promising, this systematic review still emphasizes the need for further randomized clinical trials that examine the long-term revision rate of the Stryker Triathlon TKA and the use of cementless TKAs in obese and younger populations. Only with long-term studies can we determine the survivability and clinical outcomes of cementless Stryker Triathlon in TKA.

Availability of data and material

All available data are provided. Additional data, if needed, may be made available upon request.



Total knee arthroplasty


Body mass index


Radiostereometric analysis


Patient reported outcome measure


  1. Callahan CM, Drake BG, Heck DA, Dittus RS. Patient outcomes following tricompartmental total knee replacement. A meta-analysis JAMA. 1994;271(17):1349–57.

    CAS  PubMed  Google Scholar 

  2. Steinhaus ME, Christ AB, Cross MB. Total Knee Arthroplasty for Knee Osteoarthritis: Support for a Foregone Conclusion? HSS journal: the musculoskeletal journal of Hospital for Special Surgery. 2017;13(2):207–10.

    Article  Google Scholar 

  3. Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand. 2000;71(3):262–7.

    Article  CAS  Google Scholar 

  4. Bullens PH, van Loon CJ, de Waal Malefijt MC, Laan RF, Veth RP. Patient satisfaction after total knee arthroplasty: a comparison between subjective and objective outcome assessments. J Arthroplasty. 2001;16(6):740–7.

    Article  CAS  Google Scholar 

  5. Kerkhoffs GMMJ, Servien E, Dunn W, Dahm D, Bramer JAM, Haverkamp D. The influence of obesity on the complication rate and outcome of total knee arthroplasty: A meta-analysis and systematic literature review. Journal of Bone and Joint Surgery - Series A. 2012;94(20):1839–44.

    Article  Google Scholar 

  6. Lonner JH, Hershman S, Mont M, Lotke PA. Total knee arthroplasty in patients 40 years of age and younger with osteoarthritis. Clin Orthop Relat Res. 2000;380:85–90.

    Article  Google Scholar 

  7. Wagner ER, Kamath AF, Fruth K, Harmsen WS, Berry DJ. Effect of Body Mass Index on Reoperation and Complications After Total Knee Arthroplasty. JBJS. 2016;98(24):2052–60.

    Article  Google Scholar 

  8. Julin J, Jämsen E, Puolakka T, Konttinen YT, Moilanen T. Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis. A follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta Orthopaedica. 2010;81(4):413–9.

  9. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. The Journal of Bone and Joint Surgery American. 2007;89(4):780–5.

    Article  Google Scholar 

  10. Fehring TK, Odum SM, Griffin WL, Mason JB, McCoy TH. The obesity epidemic: its effect on total joint arthroplasty. J Arthroplasty. 2007;22(6 Suppl 2):71–6.

    Article  Google Scholar 

  11. Bagsby DT, Issa K, Smith LS, Elmallah RK, Mast LE, Harwin SF, et al. Cemented vs Cementless Total Knee Arthroplasty in Morbidly Obese Patients. J Arthroplasty. 2016;31(8):1727–31.

    Article  Google Scholar 

  12. Chen C, Li R. Cementless versus cemented total knee arthroplasty in young patients: a meta-analysis of randomized controlled trials. Accessed 31.8.2020.

  13. Meneghini RM, Hanssen AD. Cementless fixation in total knee arthroplasty: past, present, and future. J Knee Surg. 2008;21(4):307–14.

    Article  Google Scholar 

  14. Chong DYR, Hansen UN, van der Venne R, Verdonschot N, Amis AA. The influence of tibial component fixation techniques on resorption of supporting bone stock after total knee replacement. J Biomech. 2011;44(5):948–54.

    Article  Google Scholar 

  15. Lombardi AV, Berasi CC, Berend KR. Evolution of Tibial Fixation in Total Knee Arthroplasty. The Journal of Arthroplasty 2007;22(4, Supplement):25–29.

  16. Moran CG, Pinder IM, Lees TA, Midwinter MJ. Survivorship analysis of the uncemented porous-coated anatomic knee replacement. The Journal of Bone and Joint Surgery American. 1991;73(6):848–57.

    Article  CAS  Google Scholar 

  17. Nafei A, Nielsen S, Kristensen O, Hvid I. The press-fit Kinemax knee arthroplasty. High failure rate of non-cemented implants. The Journal of Bone and Joint Surgery British. 1992;74(2):243–6.

  18. Duffy GP, Berry DJ, Rand JA. Cement Versus Cementless Fixation In Total Knee Arthroplasty. Clinical Orthopaedics and Related Research®. 1998;356:66–72.

    Article  Google Scholar 

  19. Berger RA, Lyon JH, Jacobs JJ, Barden RM, Berkson EM, Sheinkop MB, et al. Problems with cementless total knee arthroplasty at 11 years followup. Clin Orthop Relat Res. 2001;392:196–207.

    Article  Google Scholar 

  20. Nam D, Lawrie CM, Salih R, Nahhas CR, Barrack RL, Nunley RM. Cemented Versus Cementless Total Knee Arthroplasty of the Same Modern Design. The Journal of Bone and Joint Surgery American. 2019;101(13):1185–92.

    Article  Google Scholar 

  21. van Hamersveld KT, Marang-van de Mheen PJ, Tsonaka R, Valstar ER, Toksvig-Larsen S. Fixation and clinical outcome of uncemented peri-apatite-coated versus cemented total knee arthroplasty : five-year follow-up of a randomised controlled trial using radiostereometric analysis (RSA). The Bone & Joint Journal 2017;99-B(11):1467–76.

  22. Fricka KB, Sritulanondha S, McAsey CJ. To Cement or Not? Two-Year Results of a Prospective, Randomized Study Comparing Cemented Vs. Cementless Total Knee Arthroplasty (TKA). The Journal of Arthroplasty. 2015;30((9 Suppl)):55–8.

    Article  Google Scholar 

  23. Wang H, Lou H, Zhang H, Jiang J, Liu K. Similar survival between uncemented and cemented fixation prostheses in total knee arthroplasty: a meta-analysis and systematic comparative analysis using registers. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA. 2014;22(12):3191–7.

    Article  Google Scholar 

  24. Mont MA, Pivec R, Issa K, Kapadia BH, Maheshwari A, Harwin SF. Long-term implant survivorship of cementless total knee arthroplasty: a systematic review of the literature and meta-analysis. J Knee Surg. 2014;27(5):369–76.

    PubMed  Google Scholar 

  25. Brown TE, Harper BL, Bjorgul K. Comparison of cemented and uncemented fixation in total knee arthroplasty. Orthopedics. 2013;36(5):380–7.

    Article  Google Scholar 

  26. Bingham JS, Salib CG, Hanssen AD, Taunton MJ, Pagnano MW, Abdel MP. Clinical Outcomes and Survivorship of Contemporary Cementless Primary Total Knee Arthroplasties.

  27. Dalury DF. Cementless total knee arthroplasty: current concepts review. The Bone & Joint Journal 2016;98-B(7):867–73.

  28. Soren ToksvigLarsen MM. Peri-ApatiteTM Enhances Prosthetic Fixation in Tka-A Prospective Randomised RSA Study. Accessed 7.9.2020.

  29. Harwin SF, Levin JM, Khlopas A, Ramkumar PN, Piuzzi NS, Roche M, et al. Cementless Posteriorly Stabilized Total Knee Arthroplasty: Seven-Year Minimum Follow-Up Report. J Arthroplasty. 2018;33(5):1399–403.

    Article  Google Scholar 

  30. Sultan AA, Khlopas A, Sodhi N, Denzine ML, Ramkumar PN, Harwin SF, et al. Cementless Total Knee Arthroplasty in Knee Osteonecrosis Demonstrated Excellent Survivorship and Outcomes at Three-Year Minimum Follow-Up. J Arthroplasty. 2018;33(3):761–5.

    Article  Google Scholar 

  31. Sultan AA, Mahmood B, Samuel LT, Stearns KL, Molloy RM, Moskal JT, et al. Cementless 3D Printed Highly Porous Titanium-Coated Baseplate Total Knee Arthroplasty: Survivorship and Outcomes at 2-Year Minimum Follow-Up. J Knee Surg. 2020;33(3):279–83.

    Article  Google Scholar 

  32. Newman J, Khlopas A, Chughtai M, Gwam C, Mistry J, Yakubek G, et al. Cementless Total Knee Arthroplasty in Patients Older Than 75 Years. J Knee Surg. 2017;30(09):930–5.

    Article  Google Scholar 

  33. Cohen RG, Sherman NC, James SL. Early Clinical Outcomes of a New Cementless Total Knee Arthroplasty Design. Orthopedics. 2018;41(6):e765–71.

    Article  Google Scholar 

  34. Harwin SF, Kester MA, Malkani AL, Manley MT. Excellent Fixation Achieved With Cementless Posteriorly Stabilized Total Knee Arthroplasty. J Arthroplasty. 2013;28(1):7–13.

    Article  Google Scholar 

  35. Sinicrope BJ, Feher AW, Bhimani SJ, Smith LS, Harwin SF, Yakkanti MR, et al. Increased Survivorship of Cementless versus Cemented TKA in the Morbidly Obese. A Minimum 5-Year Follow-Up. The Journal of Arthroplasty. 2019;34(2):309–14.

    Article  Google Scholar 

  36. Harwin SF, Elmallah RK, Jauregui JJ, Cherian JJ, Mont MA. Outcomes of a Newer-Generation Cementless Total Knee Arthroplasty Design. Orthopedics. 2015;38(10):620–4.

    Article  Google Scholar 

  37. Mont MA, Gwam C, Newman JM, Chughtai M, Khlopas A, Ramkumar PN, et al. Outcomes of a newer-generation cementless total knee arthroplasty design in patients less than 50 years of age. Accessed 25.8.2020.

  38. Patel N, Gwam CU, Khlopas A, Sodhi N, Sultan AA, Navarro SM, et al. Outcomes of Cementless Total Knee Arthroplasty in Patients With Rheumatoid Arthritis. Orthopedics. 2018;41(2):103–6.

    Article  Google Scholar 

  39. Harwin SF, Patel NK, Chughtai M, Khlopas A, Ramkumar PN, 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(7):2156–60.

    Article  Google Scholar 

  40. Nam D, Kopinski JE, Meyer Z, Rames RD, Nunley RM, Barrack RL. Perioperative and Early Postoperativeerative Comparison of a Modern Cemented and Cementless Total Knee Arthroplasty of the Same Design. J Arthroplasty. 2017;32(7):2151–5.

    Article  Google Scholar 

  41. Miller AJ, Stimac JD, Smith LS, Feher AW, Yakkanti MR, Malkani AL. Results of Cemented vs Cementless Primary Total Knee Arthroplasty Using the Same Implant Design. J Arthroplasty. 2018;33(4):1089–93.

    Article  Google Scholar 

  42. Yazdi H, Choo KJ, Restrepo C, Hammad M, Sherman M, Parvizi J. Short-term results of triathlon cementless versus cemented primary total knee arthroplasty. Knee. 2020;27(4):1248–55.

    Article  Google Scholar 

  43. Boyle KK, Nodzo SR, Ferraro JT, Augenblick DJ, Pavlesen S, Phillips MJ. Uncemented vs Cemented Cruciate Retaining Total Knee Arthroplasty in Patients With Body Mass Index Greater Than 30. J Arthroplasty. 2018;33(4):1082–8.

    Article  Google Scholar 

  44. Restrepo S, Smith EB, Hozack WJ. Excellent mid-term follow-up for a new 3D-printed cementless total knee arthroplasty. The Bone & Joint Journal 2021;103-B(6 Supple A):32–37.

  45. Hasan S, van Hamersveld KT, Marang-van de Mheen PJ, Kaptein BL, Nelissen RGHH, 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. The Bone & Joint Journal 2020;102-B(8):1016–24.

  46. Middleton SWF, Schranz PJ, Mandalia VI, Toms AD. The largest survivorship and clinical outcomes study of the fixed bearing Stryker Triathlon Partial Knee Replacement — A multi-surgeon, single centre cohort study with a minimum of two years of follow-up. Knee. 2018;25(4):732–6.

    Article  CAS  Google Scholar 

  47. Mullaji A, Shetty G. Cemented total knee arthroplasty remains the “gold standard.” CURRENT CONCEPTS IN JOINT REPLACEMENT – THE KNEE 2015;26(2):62–64.

  48. Guo Y, Ma S, Wang J, Zhang Q, Wang S, Du Z. Cemented versus uncemented total knee arthroplasty in younger patients: A protocol of retrospective cohort trial. Medicine. 2020;99(18):e20087–e20087.

    Article  Google Scholar 

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BJC: Conception, design, acquisition, analysis, drafting, revisions. ASG: Conception, design, acquisition, analysis, drafting, revisions. JDH: Conception, design, drafting, revisions. ZKC: Drafting, revisions, submission. MJS: Conception, drafting, revisions, oversight. JSB: Conception, design, acquisition, analysis, drafting, revisions, oversight. Each author has approved the submitted version and has agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution is documented in the literature.

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Correspondence to Zachary K. Christopher.

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MJS is a consultant for Heraeus and receives royalties from BodyCad, and educational and research support from DePuy and Stryker. None of the other authors have financial interests to disclose.

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Carlson, B.J., Gerry, A.S., Hassebrock, J.D. et al. Clinical outcomes and survivorship of cementless triathlon total knee arthroplasties: a systematic review. Arthroplasty 4, 25 (2022).

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