Why Are Primary Total Knee Arthroplasties Failing? A Systematic Review and Meta-Analysis.

Abstract

Revision total knee arthroplasty (TKA) is a burden to patients and the health care system. The purpose of this systematic review is to identify the most likely causes for requiring a revision of TKA over the last 14 years METHODS: A comprehensive search of multiple electronic databases was performed for all articles pertaining to this topic from 2010 to 2024. A total of 16 studies were included in this review. Our final cohort consisted of 1,383,181 revision arthroplasties. Approximately 31% of revisions had unspecified etiology. The most common documented etiologies for revision were periprosthetic joint infection (22.3%) and aseptic loosening (20.5%). Other common etiologies were instability (7%), implant breakage (3.6%), dislocation (3%), osteolysis (2.4%), and polyethylene wear (2%). The most common causes for early (< 2 years) and late (> 2 years) revision were infection and aseptic loosening, respectively. Infection and aseptic loosening were the most common causes for early and late revision TKA, respectively. Future studies should assess the role of advancements in surgical techniques and component design to alter these revision risks.