Abstract
Revision total knee arthroplasty (RTKA) represents an effective treatment for failed
TKA, but with less favorable outcomes. Considering the technical complexity and economic
burden of RTKA procedures, it is mandatory to investigate current mechanisms and predictors
for RTKA failure. The objective of this study is to evaluate the survivorship and
determine the predominant causes of failure of RTKA. A total of 146 patients undergoing
RTKA between 2003 and 2013 were identified from the institutional database. Revision
was defined as surgery in which the whole prostheses (inlay and both femoral and tibial
components) required exchange. Median follow-up was 6.3 ± 2.7 years (range: 2.2–10).
Patient demographics, year of primary implantation, reasons for revision surgery,
implant type, pain, knee mobility, systemic or local postoperative complications,
and treatment of the complications were recorded and evaluated. Infection was a major
cause of failure followed by aseptic loosening, instability, pain, malalignment, and
inlay wear. Following RTKA, Knee Society Score (KSS) (knee score and functional score)
demonstrated a significant improvement (p < 0.05). No significant difference in flexion, extension deficit, and KSS was detected
between aseptic and septic primary TKAs preoperatively and following first RTKA. Reinfection
rate of the septic primary TKAs was 5%. Infection was the major cause of a second
revision, reaching as high as 50% in all cases. The results of this study support
that septic failure of a primary TKA is likely to occur within the first 2 years following
implantation. Septic failure of primary TKA does not influence survival of the revision
prosthesis.
Keywords
total knee arthroplasty - revision total knee arthroplasty - failure - survivorship
