Age May Not be a Barrier: Cementless Total Knee Arthroplasty Yields Equivalent or Superior PROMs in Older Adults at One Year

Abstract Background Cementless total knee arthroplasty (TKA) is increasingly being used across the age spectrum, yet its impact on patient-reported outcomes (PROMs) in older adults remains understudied. As value-based care initiatives prioritize PROMs such as pain relief, functional recovery, and satisfaction, understanding age-specific differences is critical. Methods We analyzed 1772 patients who underwent unilateral, fully cementless primary TKA between 2016 and 2023 using a prospectively collected institutional registry. Patients were stratified by age (≤ 60, 60–70, > 70 years), and outcomes included KOOS subscales (Pain, Physical Function Shortform [PS], and Joint Replacement [JR]), minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and satisfaction at 1 year. Multivariable logistic regression adjusted for baseline PROMs and demographic covariates. Results Older patients (> 70) had significantly higher baseline KOOS scores and were more likely to exhibit favorable PROM phenotypes compared to younger cohorts. At 1 year, all groups experienced substantial improvement, with the > 70 group achieving the highest absolute KOOS scores. Patients aged 60–70 had significantly lower odds of failing to meet MCID (KOOS JR: OR 0.58; p = 0.027) and PASS thresholds (KOOS Pain: OR 0.75; KOOS PS: OR 0.75) compared to those ≤ 60. Older adults demonstrated non-inferior performance across all metrics, including satisfaction, which exceeded 83% across all age groups (p = 0.88). Conclusion Cementless TKA yields strong MCID and PASS threshold achievement and high satisfaction across all age groups. Patients over 70 demonstrated excellent outcomes, challenging traditional age-based concerns and may encourage the use of cementless fixation in appropriately selected older adults. However, long-term data evaluating implant survivorship remains warranted.