When Your Knee Gives Out: What Are Your Replacement Options?

For the more than 700,000 Americans who undergo knee replacement surgery each year, the procedure itself has long felt like a foregone conclusion — a last resort after years of pain, stiffness, and failed treatments. What some patients may not realize is that today, there is a meaningful choice to be made about how that surgery is performed. So what are the options and which option is best for you?

Bryant Bonner, MD, a board-certified orthopedic surgeon with Sah Orthopaedic Associates at Washington Health’s Institute for Joint Restoration and Research in Fremont, has spent his career specializing in hip and knee replacements. He will share his expertise in an online presentation, “The Science of Cementless Knee Replacement,” at 10 a.m. on June 6, available live on YouTube at YouTube.com/@washington_health. The following day, the recording will be added to Washington Health’s video library for viewing.

Most knee pain that is severe enough to require replacement stems from osteoarthritis, a condition in which the cartilage cushioning the joint between the thigh bone and shin bone gradually breaks down over years of use. More than 32 million Americans live with knee osteoarthritis, and it is the leading cause of disability among adults under 65.

Surgery, however, is not the first step. Dr. Bonner typically explores a range of non-surgical treatments first — among them lifestyle modifications, anti-inflammatory medications, and corticosteroid or lubricating injections. Only when pain persists despite three or more months of conservative care, and/or a patient’s quality of life has been meaningfully diminished, is it time to consider surgical intervention.

Once surgery is indicated, there are two proven methods for securing the artificial knee to existing bone.

The traditional approach uses a specialized orthopedic cement — similar in concept to grout — to fill the small gaps between the implant and the patient’s thigh and shin bones, creating a secure bond. It has decades of data behind it and remains highly effective, particularly for patients whose bone density may have declined with age.

The newer cementless technique takes a different approach entirely. The implant is designed with a porous surface that allows the patient’s own bone to grow directly in to it over time, creating a biological bond. No adhesive is required, but the process demands high-quality, healthy bone tissue to succeed.

“Successful cementless knee replacement is dependent on the quality of the patient’s knee bones,” he explains. “In many patients, the knee bones are often worn and not as robust as they might have been at their peak, and therefore not suitable for the cementless process. However, there are patients who have strong, healthy bone that are well suited for a cementless implant allowing for good bony ingrowth and the potential for a very long lasting, stable implant.”

Age is one of several factors, but it is primarily the overall bone health and quality that is a critical determining factor for a cementless implant. For patients with compromised bone density, the cemented method remains the gold standard. It is reliable, well-studied, and highly successful at eliminating pain and restoring mobility.

For younger, more active patients, cementless replacement has become increasingly preferred. Because the implant integrates directly with living bone, it has the potential to outlast a cemented knee — a critical consideration for a 50-year-old who may need the replacement to last 30 or more years. Robotic-assisted surgery, Dr. Bonner adds, helps ensure the precise and accurate fit that cementless bonding requires.

This distinction matters more now than ever: according to federal health research data, demand for total knee replacement among patients aged 45 to 64 has increased 240% in recent years — and that figure does not account for the growing share of procedures performed in outpatient settings.

The technology surrounding knee replacement continues to advance. Robotic surgical systems, next-generation implant materials, and refinements in cementless bonding techniques are all improving outcomes and expanding which patients are eligible for each approach, Dr. Bonner notes.

His advice to anyone managing chronic knee pain is straightforward: do not wait. “Total knee replacement is highly successful — it can eliminate pain and improve your quality of life. Cementless technology allows the potential for these implants to last even longer so that even younger patients can return to an active, high quality of life sooner rather later.”

Find Dr. Bonner’s, “Cementless Knee Replacement” seminar on Saturday, June 6, at 10 a.m. on YouTube.com/@washington_health. To learn more about Dr. Bryant Bonner, visit the Meet Our Team section at WashingtonHealth.com/IJRR.