Trends in the reasons for revision total knee arthroplasty

Abstract

Introduction: As the number of annual total knee arthroplasty (TKA) procedures increases the number of revision surgeries will continue to increase. Several prior studies have identified various mechanisms of TKA failure and reported a number of reasons as the most common causes. The purpose of this review was to evaluate the causes of revision TKA at a single institution and to compare those reasons with previously published data in order to provide a current update on the topic. Methods: A retrospective review of all patients undergoing TKA revision by board-certified surgeons at a single institution between January 2, 2014 and October 16, 2020 was conducted. Statistical analysis was performed to identify trends among revision reasons and compare postoperative outcomes. Results: Of the 548 patients, 179 (32.7%) had an early revision and 369 (67.3%) had a late revision. The most common causes for early revision were infection (31.3%), loosening (27.4%), and instability (10.1%). The most common causes for late revision were loosening (29.5%), infection (22.2%), and polyethylene wear (20.3%). Postoperatively, there were no significant differences in OR time, length of stay, discharge status, 30-day readmission rates, or 30-day emergency department return rates between early and late revisions. Discussion: This study demonstrated the main causes for revision at a high-volume orthopedic joint replacement center. The most common reasons for revision were infection, loosening, instability, and polyethylene wear. This data in comparison to studies in the past suggests that the causes of revision are constantly evolving and need to be reassessed periodically in order to align focus on improvement.