Etiology of Failure in Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Abstract

Revision total knee arthroplasty (TKA) remains a burden and will continue to increase in incidence. The purpose of this systematic review and meta-analysis was to analyze the current revision rates and most common etiologies of failure of revision TKA. A comprehensive search of multiple electronic databases (PubMed, CINAHL Plus, EMBASE, and SCOPUS) was performed for all articles pertaining to this topic from 2014 to 2025. A total of 16 studies were included in this study. Study characteristics, patient demographics, rate of re-revision, and etiology for revision failures were extracted from each study. Among 39,723 revision arthroplasties, the re-revision rate for this cohort was 13.5% (n = 5,350 revisions). The most common etiologies for revision failure were periprosthetic joint infection (27.5%; 95% CI [confidence interval], 26.4 to 28.8), instability (13.6%; 95% CI, 12.7 to 14.5), aseptic loosening (12.8%; 95% CI, 11.9 to 13.7), arthrofibrosis (9.4%; 95% CI, 8.5 to 10.4), unexplained pain (8.0%; 95% CI, 7.1 to 8.9), and periprosthetic fracture (7.6%; 95% CI, 6.8 to 8.5). There was substantial heterogeneity found among the studies, with very few showing publication bias. Our revision failure rate of 13.5% is similar to other studies. The most common etiologies for revision TKA failure were infection, instability, and aseptic loosening. Future studies should focus on patient- and surgery-specific factors that could maximize the safety and efficacy of revision TKA.