Causes, Risk Factors, and Trends in Failures After TKA in Korea Over the Past 5 Years: A Multicenter Study

Abstract

Background Failure after total knee arthroplasty (TKA) may be related to emerging technologies, surgical techniques, and changing patient demographics. Over the past decade, TKA use in Korea has increased substantially, and demographic trends have diverged from those of Western countries, but failure mechanisms in Korea have not been well studied.Questions/purposes We determined the causes of failure after TKA, the risk factors for failure, and the trends in revision TKAs in Korea over the last 5 years. The Knee Society, patient demographics, information on index and revision of TKAs, and indications for index TKA. The influences of patient demographics and indications for index TKA on the risk of TKA failure were evaluated using multivariate regression analysis. The trends in revision procedures and demographic features of the patients undergoing revision TKA over the last 5 years were assessed. Results The most common cumulative cause of TKA failure was infection (38%) followed by loosening (33%), wear (13%), instability (7%), and stiffness (3%). However, the incidence of infections has declined over the past 5 years, whereas that of loosening has increased and exceeds that of infection in the more recent 3 years. Young age (odds ratio [OR] per 10 years of age increase, 0.41; 95% confidence interval [CI], 0.37-0.49) and male sex (OR, 1.88; 95% CI, 1.42-2.49) were associated with an increased risk of failure. The percentage of revision TKAs in all primary and revision TKAs remained at approximately 3%, but the annual numbers of revision TKAs in the more recent 3 years increased from that of 2008 by more than 23%. Conclusions Despite a recent remarkable increase in TKA use and differences in demographic features, the causes and risk factors for failures in Korea were similar to

Trends in High Tibial Osteotomy and Knee Arthroplasty Utilizations and Demographics in Korea From 2009 to 2013

“…Further studies of more detailed demographic characteristics and carefully updated long term follow up of each procedure are required for establishment of appropriate healthcare strategies for managing the knee arthritis. [9]; CIHI = Canadian Institute of Health Information [10]; NJR = National Joint Registry for England, Wales and Northern Ireland [11]; FNHDR = Finnish National Hospital Discharge Register [29]; NZJR = New Zealand Joint Registry [12]; NAR = Norwegian Arthroplasty Register [13]; SKAR = Swedish Knee Arthroplasty Register [14]. a Percentage of the TKA number in the latest record.…”

“…As trends in the utilization of these surgical procedures are closely associated with emerging new technologies and changing demographics, carefully updated information is of paramount importance [9][10][11][12]. Recently, as advances in technology and understanding of the most appropriate surgical technique of HTO and UKA have improved clinical outcome and survivorship, they are being increasingly recognized as reasonable treatment options for unicompartmental knee arthritis in active younger patients [13][14][15][16][17][18][19][20].…”

“…Over the past decade, in Korea, TKA use has increased markedly and has reached the level of most developed Western countries [3,12]. Meanwhile, changes in several demographic and lifestyle characteristics that might affect the uses of those surgical procedures have been noted in Korea, including more frequent varus knee deformity [30][31][32], more frequent squatting and kneeling in daily activities [33,34], the greater use of TKA in elderly patients (≥65 years) with a pronounced female predominance, and decreasing TKA use in younger patients (b 65 years) [3,34].…”

Open debridement and prosthesis retention is a viable treatment option for acute periprosthetic joint infection after total knee arthroplasty

“…Worldwide, PJI is the most common cause of revision TKA [3,11,13], the incidence of which is projected to increase [16,19]. Open debridement with prosthesis retention (ODPR), which involves thorough irrigation and debridement (I & D), with retention of the prosthesis and administration of intravenous antibiotics, is viewed as a reasonable treatment option for early postoperative infections (developing within 4 weeks after index TKA) or acute hematogenous infections in which symptom duration is 4 weeks or less [28,31,32].…”

Gentamicin coating of nanotubular anodized titanium implant reduces implant-related osteomyelitis and enhances bone biocompatibility in rabbits

“…Infection and aseptic loosening are the two major causes of surgical failure, with reported incidences of 25.2% and 16.1%, respectively, in the US, and 38% and 33%, respectively, in South Korea. 4,5 On the other hand, poor biocompatibility of the prosthesis with surrounding bone tissues or stress shielding is the main culprit for aseptic loosening, which may subsequently lead to bacterial contamination and infection. Implant removal and revision are the major therapeutic methods for patients suffering from infection or Meanwhile, orthopedic surgical-site infection prolongs hospital stay by a median of 2 weeks, doubles readmission rate and triples hospital care costs.…”