The Epidemiology of Revision Total Knee Arthroplasty

Abstract

With an expected increase in total knee arthroplasty (TKA) procedures, revision TKA (rTKA) procedures continue to be a burden on the United States health care system. The evolution of surgical techniques and prosthetic designs has, however, provided a paradigm shift in the etiology of failure mechanisms of TKA. This review can shed light on the current reasons for revision, which may lead to insights on how to improve outcomes and lower future revision risks. We will primarily focus on the epidemiology of rTKA in the present time, but we will also review this in the context of various time periods to see how the field has evolved. We will review rTKAs: 1) prior to 1997; 2) between 1997 and 2000; 3) between 2000 and 2012; and 3) in the modern era since 2012. We will further subdivide each of the sections into reasons for early (first 2 years after index procedure) versus late revisions (greater than 2 years after index procedure). In doing so, it was determined that prior to 1997, the most prevalent causes of failure were infection, patella failure, polyethylene wear, and aseptic loosening. After a major shift of failure mechanisms was described by Sharkey et al, polyethylene wear and aseptic loosening became the leading causes for revision. However, with the improved manufacturing technology and implant design, polyethylene wear was replaced with aseptic loosening and infection as the leading causes of failure between 2000 and 2012. Since that time, in the modern era of TKA, mechanical loosening and infection have taken over the most prevalent causes for failure. Hopefully, with continued developments in component design and surgical techniques, as well as increased focus on infection reduction methods, the amount of rTKA procedures will decline.

Effectiveness and Accuracy of a Patient‐Specific Instrumentation System for Total Hip Arthroplasty

“…Position of the prosthesis is one of the key factors that affect surgical outcomes. Inappropriate position often leads to impingement, dislocation, limited range of motion, reinforced wear of the prosthesis, and so forth, 1 , 2 and eventually instability and failure, 3 , 4 which require revision surgery. This exerts substantial physical and financial burdens on the patient.…”

An Experimental Study on the Impact of Prosthesis Temperature on the Biomechanical Properties of Bone Cement Fixation

“…In recent years,the incidence of joint diseases has increased year by year,and the number of orthopedic implants used for joint replacement has increased year by year (10).But inadequate cement technology can affect the prosthetic retention rate and other complications (11).Aseptic loosening is one of the leading causes of implant failure,with approximately 18% of implant failures due to aseptic loosening (12).Since the xation strength of bone cement is an important reason for the aseptic loosening of the prosthesis,our results showed that the xation strength of the femoral prosthesis is higher than that of the tibial plateau prosthesis,and increasing the temperature of the prosthesis before bonding can improve the xation strength of the bone cement,and prosthesis xation strength is positively correlated with temperature,and the aim of this study was to provide some information that might reduce the incidence of tibial component loosening.…”

Is Conversion Total Knee Arthroplasty a Distinct Surgical Procedure? A Comparison to Primary and Revision Total Knee Arthroplasty

“…Conversion TKAs can be challenging procedures that incur similar complication rates to revision arthroplasties. [1][2][3][4][5][6][7][8][9][15][16][17][18][19][20] However, current billing codes do not allow for the differentiation between this more difficult operation and potentially simpler primary TKAs. 1,7,8 Furthermore, there is a lack of large studies elucidating this necessary distinction.…”