Cementless total knee arthroplasty (TKA) has become a viable option in recent years, and there has been an increase in robotic-assisted technology. Although institutions may monitor their implant usage, the evolution of their use and complication rates have not been well described at a national level in the United States. Therefore, we sought to characterize the use and compare complications between cemented, cementless, manual, and robotic-assisted TKA across the United States.

We retrospectively reviewed a commercial claims database and found 94,603 inpatient primary TKAs that were performed with cemented or cementless components between January 1, 2016 and December 31, 2022. Records were reviewed for demographics, use of robotics, complications, and readmissions up to 90 days postoperatively.

More cementless TKAs were performed each year, from 4.1% in 2016 to 12.3% in 2022 (odds ratio [OR] = 1.3, p < 0.001). The use of robotic technology increased each year from 7.7% in 2016 to 25.0% in 2022 (OR = 1.3, p < 0.001) and was more commonly used with cementless TKA (OR = 1.3, p < 0.001). Patient factors associated with cementless TKA included younger age (OR = 1.0, p < 0.001) and male sex (OR = 1.3, p < 0.001). Cementless TKA was a risk factor for explantation within 90 days postoperatively (OR = 1.5, p = 0.008), but not aseptic loosening (OR = 0.8, p = 0.6), periprosthetic fracture (OR = 0.2, p = 0.2), infection (OR = 1.3, p = 0.1), revision TKA (OR = 1.4, p = 0.1), manipulation under anesthesia (OR = 1.0, p = 0.9), deep vein thrombosis (OR = 0.9, p = 0.5), pulmonary embolism (OR = 1.2, p = 0.3), or blood transfusion (OR = 0.3, p = 0.1).

The use of cementless and robotic TKA is increasing each year, although most inpatient primary TKAs are still performed with manual cemented technique. Although cementless TKA was found to be a risk factor for revision and explanation within 90 days, it was not associated with a specific cause of revision. Further research is needed to better understand why cementless TKA increases these risks.

Received: 17 February 2025

Accepted: 26 September 2025

Accepted Manuscript online:
30 September 2025

Article published online:
28 October 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA