Failed Total Knee Arthroplasty

Abstract

Total knee arthroplasty is one of the most successful interventions for reducing knee pain and for improving function and quality of life. Advances in implant materials and design as well as surgical technique have increased the longevity of prostheses and have decreased the rate of revision surgery to <5% within ten years1. In light of the rapidly growing demand for knee arthroplasty, especially in younger and more active patients, the number of revision procedures is projected to grow sevenfold, from 38,000 in 2005 to 270,000 by 20302,3. Understanding the causes of failure is essential for guiding future strategies to optimize safety and outcome as well as the utilization of healthcare resources. The failure of total knee arthroplasty presents clinical challenges to orthopaedic surgeons and their patients. A systematic evaluation is crucial for identifying the mechanism of failure and for developing an appropriate treatment protocol. Once the diagnosis has been established, the treatment can then be divided into operative and nonoperative options. The failure of total knee arthroplasty does not necessarily imply the need for revision surgery. It is important to avoid surgical intervention before a diagnosis is made, even in cases of pain with no clear etiology4,5. The modes of failure of total knee replacement can be classified as intra-articular or extra-articular, as biological or mechanical, as early or late, or according to the predominant symptom, …