Last reviewed: September 29, 2026

For most people, probably not much. Both work well, and the knee usually feels and works about the same either way.

In a cemented knee replacement, the parts are fixed to the bone with a fast-setting bone cement. In a cementless one, the parts are pressed into the bone, and bone grows into their rough surface over the following weeks. Some surgeons use a mix, cementing one part and not the other. Cement is used far more often and has the longest track record, but cementless knees are becoming more common in the United States.

According to the American Academy of Orthopaedic Surgeons, cemented, cementless and mixed fixation give similar function, complications and redo operations, though the evidence is conflicting. Randomized trials found no clear difference in how long the knee lasts or how well it works. Cementless operations were a little shorter, and in some studies bled more.

Large national joint registries, which follow hundreds of thousands of knees, found slightly more redo operations with cementless knees in several countries. The difference was small. In England, about 1 in 200 more knees needed a redo within ten years. Other registries found no difference. Cementless knees tend to go to younger people and to men, who have more redo operations anyway, which makes the comparison harder.

The particular implant matters. Some cementless designs did as well as their cemented versions, and others did worse.

Studies disagree on age. One pooled review found cementless knees lasted better in people under 60, while several registries found the opposite. In one American registry, women over 70 had more early redo operations with cementless knees.

In general:

  • Ask your surgeon which kind of fixation they plan to use, and why.
  • Ask how long they have used that particular implant and how it has done.

Drafted with AI assistance from published sources, reviewed and edited by Babak Sheikh, MD.

Sources:

  • American Academy of Orthopaedic Surgeons. Surgical Management of Osteoarthritis of the Knee: Evidence-Based Clinical Practice Guideline. 2022. https://www.aaos.org/globalassets/quality-and-practice-resources/surgical-management-knee/smoak2cpg.pdf
  • Prasad AK, et al. Cemented vs. Cementless Fixation in Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. EFORT Open Rev. 2020. https://doi.org/10.1302/2058-5241.5.200030
  • Hannon CP, et al. Cementless Versus Cemented Total Knee Arthroplasty: Concise Midterm Results of a Prospective Randomized Controlled Trial. J Bone Joint Surg Am. 2023. https://doi.org/10.2106/JBJS.23.00161
  • Lisacek-Kiosoglous AB, et al. Radiological and Clinical Outcomes of Cementless Versus Cemented Implants in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. Bone Joint J. 2025. https://doi.org/10.1302/0301-620X.107B10.BJJ-2024-1358.R1
  • Mercurio M, et al. Cemented Total Knee Arthroplasty Shows Less Blood Loss but a Higher Rate of Aseptic Loosening Compared With Cementless Fixation: An Updated Meta-Analysis of Comparative Studies. J Arthroplasty. 2022. https://doi.org/10.1016/j.arth.2022.04.013
  • Mohammad HR, et al. A Matched Comparison of the Long-Term Outcomes of Cemented and Cementless Total Knee Replacements: An Analysis From the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man. J Bone Joint Surg Am. 2021. https://doi.org/10.2106/JBJS.21.00179
  • Nugent M, et al. Despite Improved Survivorship of Uncemented Fixation in Total Knee Arthroplasty for Osteoarthritis, Cemented Fixation Remains the Gold Standard: An Analysis of a National Joint Registry. J Arthroplasty. 2019. https://doi.org/10.1016/j.arth.2019.03.047
  • Niemeläinen MJ, et al. The Effect of Fixation Type on the Survivorship of Contemporary Total Knee Arthroplasty in Patients Younger Than 65 Years of Age: A Register-Based Study of 115,177 Knees in the Nordic Arthroplasty Register Association (NARA) 2000-2016. Acta Orthop. 2020. https://doi.org/10.1080/17453674.2019.1710373
  • 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. https://doi.org/10.1016/j.arth.2025.03.007
  • Hilow HJ, et al. United States Trends in Utilization and One-Year Revision Risk of Cementless Total Knee Arthroplasty: An Analysis of American Joint Replacement Registry Data. J Arthroplasty. 2026. https://doi.org/10.1016/j.arth.2026.06.050
  • Kagan R, et al. Selective Use of Modern Cementless Total Knee Arthroplasty Is Not Associated With Increased Risk of Revision in Patients Aged 65 or Greater: An Analysis From the American Joint Replacement Registry. J Knee Surg. 2024. https://doi.org/10.1055/a-2332-5762
  • Chen AG, et al. Survivorship of Modern Cementless Total Knee Arthroplasty: Analysis From the Canadian Joint Replacement Registry. J Arthroplasty. 2024. https://doi.org/10.1016/j.arth.2024.08.003
  • 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. https://doi.org/10.1097/CORR.0000000000003385
  • Powell DT, et al. Early Survivorship of Uncemented Total Knee Arthroplasty Varies by Age and Sex Based on Data From the Michigan Arthroplasty Registry Collaborative Quality Initiative. J Arthroplasty. 2023. https://doi.org/10.1016/j.arth.2023.02.073

This is general information about what published research shows. It is not medical advice and it is not about your situation. Reading it does not create a doctor-patient relationship with me. I am a retired orthopedic surgeon and I do not see patients. Talk with your own doctor before changing anything about your care. If something feels suddenly or seriously wrong, get medical care promptly rather than waiting.

This page is provided as is. I make no guarantee that it is accurate, complete or current, and medical evidence changes. Use of it is at your own risk.

Published by Clinical Evidence Media LLC. Full disclaimer and how these answers are researched: Disclaimer and how these answers are made