Why are Total Knee Arthroplasties Being Revised?

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Abstract

Despite technical improvements, revision rates for total knee arthroplasties (TKAs) remain high. Our goal was to report the reason(s) for revision TKA in a large, current, multicenter series and compare those reasons with previously published reasons. We retrospectively identified 820 consecutive revision TKAs (693 patients, 2000–2012) from our 3 centers and recorded the primary reason for the revision. The top seven reasons for the revision were aseptic loosening (23.1%), infection (18.4%), polyethylene wear (18.1%), instability (17.7%), pain/stiffness (9.3%), osteolysis (4.5%), and malposition/malalignment (2.9%). Comparison with previously published reasons showed fewer TKA revisions for polyethylene wear, osteolysis, instability, and malalignment. These changes may represent improvements in surgical technique and implants.

Section snippets

Materials and Methods

After receiving institutional review board approval, we retrospectively reviewed our patient databases at 3 separate centers and identified 820 consecutive knees (693 patients) that had undergone a RTKA from 2000 through 2011. We defined revision as a reoperation for any reason. We did not include any reoperations on unicondylar knee replacements in our series. The 410 women and 283 men had a mean age of 69 years (range, 24–94 years), a mean body mass index of 31 kg/m2 (range, 18–60 kg/m2), and a

Results

Overall, the 6 most frequent reasons for revision were aseptic loosening (23.1%), infection (18.4%), polyethylene wear (18.1%), instability (17.7%), pain/stiffness (9.3%), osteolysis (4.5%), and malposition (2.9%) (Table 8., 9.). We considered instability and malposition to be predominantly influenced by the surgeon; these 2 reasons represented 21% of all revisions.

When the causes of revision were subdivided by time into “early” (less than 5 years [60 months]) and “late” (equal to or more than 5 

Discussion

Although there is general agreement on the success of primary TKA, RTKA does not compare as well. The costs of RTKA are high and the results, compared with primary TKA, are inferior [10]. Ong et al [11] showed that a RTKA has a 5 to 6 times increased risk of re-revision. In a recent study, Baker et al [12] showed that improvement after a RTKA was only 69%–76% of a primary TKA and that the Medicare database showed the 5-year survivorship of RTKA to be only 87%.

Our series shows that, compared

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The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.04.051.

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