Comparable Early Outcomes Between Cemented and Cementless MAKO Functional Alignment Total Knee Arthroplasty: A Propensity-Matched Analysis

Abstract

Cemented fixation remains the gold standard in total knee arthroplasty (TKA); however, growing interest in cementless fixation has emerged due to potential advantages in biological osseointegration and long-term implant survivorship. Limited data exist comparing these fixation methods in robotic-assisted TKA using functional alignment (FA), particularly in Asian populations who may present with distinct anatomical and demographic characteristics. This study compared early clinical outcomes between cemented and cementless MAKO-assisted FA-TKA in an Asian cohort using propensity score matching. 148 consecutive patients undergoing MAKO-assisted FA-TKA were retrospectively reviewed. Following 1:1 propensity score matching for baseline demographics and deformity characteristics, 45 cemented and 45 cementless cases were compared. Outcomes included early postoperative pain, ambulation, range of motion, and patient-reported outcome measures (KSKS, KSFS, OKS, SF-36), alongside satisfaction and expectation fulfilment assessed at six months. Groups were well-matched at baseline. No significant differences were observed in early postoperative recovery metrics or six-month functional outcomes between the two fixation groups, except for a marginally higher SF-36 mental component score in the cemented group (57.7 ± 8.2 vs. 52.4 ± 11.3; p =0.043). Rates of MCID achievement, patient satisfaction, and expectation were comparable between groups. Cementless MAKO-assisted FA-TKA demonstrated comparable early clinical and patient-reported outcomes to cemented fixation in this propensity-matched Asian cohort, suggesting it is a viable alternative fixation strategy in appropriately selected patients. However, longer follow-up is required to evaluate implant durability, osseointegration, and survivorship before broader conclusions can be drawn.