Ninety-day readmission and early complications after coding-defined cementless-category versus cemented-category primary total knee arthroplasty.

Publication date: Aug 05, 2026

Use of cementless total knee arthroplasty (TKA) has increased in recent years, but contemporary short-term administrative comparisons with cemented fixation remain limited. This study compared 90-day readmission and early postoperative complications after ICD-10-PCS coding-defined cementless-category versus cemented-category primary TKA using a large U. S. administrative readmission database. The 2020-2022 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD) was queried for adults undergoing elective unilateral primary TKA for osteoarthritis. Only cases performed on hospital day 0 using common cemented and cementless ICD-10-PCS procedure codes were included. Fixation category was defined using ICD-10-PCS administrative procedure coding and was analyzed as coding-defined cementless-category versus cemented-category primary TKA. Non-elective admissions, bilateral procedures, revision or reoperation cases, fracture-, malignancy-, infection-, and COVID-19-related admissions, and index discharges after September were excluded. Readmissions involving contralateral knee arthroplasty were also excluded. Propensity-score matching was performed on the unweighted analytic sample, and DISCWT was applied after matching to generate weighted national estimates and proportions. The primary outcome was 90-day all-cause readmission. Secondary outcomes included intraoperative fracture, blood loss anemia, blood transfusion, stratified in-hospital complications, readmission burden, grouped primary causes of readmission, and grouped principal procedures performed during readmission. The 1:1 matched analytic cohort included 23,140 unweighted admissions in each coding-defined fixation category. After applying DISCWT, these corresponded to weighted national estimates of 40,490 cemented-category and 40,501 cementless-category primary TKA admissions. Coding-defined cementless-category TKA was associated with a lower weighted 90-day readmission proportion compared with cemented-category TKA (5. 17% vs 5. 76%; OR 0. 89, 95% CI 0. 84-0. 95; p 

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