What Are the Causes of Revision Total Knee Arthroplasty in Japan?

Abstract

Background There is limited information regarding the cause of revision TKA in Asia, especially Japan. Owing to differences in patient backgrounds and lifestyles, the modes of TKA failures in Asia may differ from those in Western countries. Questions/purposes We therefore determined (1) causes of revision TKA in a cohort of Japanese patients with revision TKA and (2) whether patient demographic features and underlying diagnosis of primary TKA are associated with the causes of revision TKA. Methods We assessed all revision TKA procedures performed at five major centers in Hokkaido from 2006 to 2011 for the causes of failures. Demographic data and underlying diagnosis for index primary TKA of the revision cases were compared to those of randomly selected primary TKAs during the same period. Results One hundred forty revision TKAs and 4047 primary TKAs were performed at the five centers, indicating a revision burden of 3.3%. The most common cause of revision TKA was mechanical loosening (40%) followed by infection (24%), wear/osteolysis (9%), instability (9%), implant failure (6%), periprosthetic fracture (4%), and other reasons (8%). The mean age of patients with periprosthetic fracture was older (77 versus 72 years) and the male proportion in patients with infection was higher (33% versus 19%) than those of patients in the primary TKA group. There was no difference in BMI between primary TKAs and any type of revision TKA except other causes. Conclusions The revision burden at the five referral centers in Hokkaido was 3.3%, and the most common cause of revision TKA was mechanical loosening followed

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

“…Our finding of no association between obesity and TKA failure may be associated with a relatively low prevalence of severe obesity in Asian patients. This interpretation was echoed by a previous study reporting that obesity was not a risk factor for TKA failures in Japanese patients [22]. On the other hand, the identified risk factors, male sex and younger age, concur with previous studies reporting a higher revision rate for younger patients [1,14,18,23,34,39,45], a higher association between wear and young age [19,37], and a higher incidence of infection in males [1,22].…”

“…mechanisms, except for a higher proportion of patellar resurfacing (14%-23% in Western countries versus 1% in this study) and unidentified pain (9%-31% in Western countries versus 0.3% in this study) in nationwide TKA registry data in Western countries [1,2,19,22,35,36,[42][43][44]. The reason why the incidence of unidentified pain was higher in TKA registry reports is unclear, but it may be associated with the use of different definitions of failures among countries.…”

“…This interpretation was echoed by a previous study reporting that obesity was not a risk factor for TKA failures in Japanese patients [22]. On the other hand, the identified risk factors, male sex and younger age, concur with previous studies reporting a higher revision rate for younger patients [1,14,18,23,34,39,45], a higher association between wear and young age [19,37], and a higher incidence of infection in males [1,22]. However, this study does not provide clues to understand why male sex increases the risk for infection, and future studies are warranted to elucidate this issue and to reduce infection in male patients.…”

“…However, few studies have elucidated the causes of failure after TKA in Asian patients. Indeed, only one study in the current literature focused on Asian patients and reported that the common causes of TKA failure in Japan were loosening, infection, wear/osteolysis, and instability [22]. Moreover, the causes and risk factors for failure after TKA in Korea have not been elucidated, and the longitudinal trends in revision TKA remain unclear.…”

Review of the Relationship Between Knee Alignment and Fixed Flexion Deformity and How This Can Influence Total Knee Arthroplasty: A Retrospective Cohort Study

“…15 Mechanical loosening is the most common reason for revision surgery for TKA. 12 Malalignment of the lower limb is a significant contributing factor of abnormal forces across the knee joint that can lead to early loosening. 9 Achievement of accurate leg alignment and soft tissue balancing can be challenging, and computer navigation during TKA can be useful for predicting the amount of soft tissue release required for adequate alignment.…”