To evaluate operative timeand postoperative efficacy between cementless and cemented prostheses for media knee osteoarthritis.

Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were searched in medical electronic databases, including PubMed, Excerpt Medica Database (Embase), Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and China Science and Technology Journal Database (VIP), from the establishment of the databases up to September 2024. Exclusion criteria:duplicates, low-quality studies, non-compliant outcome measures, and unavailable full texts. The quality and risk of bias of the included studies were assessed using the Cochrane Risk of Bias Tools and Newcastle-Ottawa scale (NOS). Meta-analysis was performed using RevMan 5.4.

A total of 17 studies (five RCTs, 12 CCTs) were included, involving 39 464 cases (20 405 cementless vs. 19 059 cemented unicompartmental knee arthroplasties demonstrated that cementless prostheses had shorter operative time [mean difference (MD) =9.08, 95% confidence interval (CI) (6.89, 11.28), P<0.001], slightly lower one-year survival rates[OR=1.28, 95% CI (1.02, 1.61), P=0.03], higher 5-year survival rates [odds ratio (OR) =0.73, 95% CI (0.63, 0.84), P<0.0001]. No statistically significant difference was found in postoperative range of motion [MD= -1.22, 95% CI (-4.83, 2.38), P=0.51] and complication rates[OR=0.83, 95% CI (0.68, 1.02), P=0.08]between the two groups during follow-up.

Cementless prosthesis presents many advantages such as shorter operative time, lower revision rates during follow-up, and higher five-year survival rates, while postoperative range of motion and complication rates during follow-up between cementless and cemented prostheses may not be very different .