Risk factors for asseptic loosening after revision total knee replacement (rTKR): a component-specific analysis of femoral and tibial reconstruction.

Abstract

Revision total knee arthroplasty (rTKA) remains a technically demanding procedure, with re-revision representing a major clinical challenge. The role of reconstruction strategies, particularly the use of augments and metaphyseal sleeves, in influencing the risk of re-revision remains incompletely defined. To identify factors associated with re-revision following rTKA, with a component-specific analysis of femoral and tibial reconstruction. A secondary objective was to assess radiographic fixation using the D'Amato scoring system. A retrospective analysis of 215 rTKAs was performed. Patients undergoing revision for aseptic loosening were included. The primary endpoint was the identification of factors associated with re-revision. Demographic and clinical variables, implant-related factors (use of augments and metaphyseal sleeves), and radiographic fixation (D'Amato score) were analyzed separately for femoral and tibial components. A minimum follow-up of 2 years was required. A total of 12 cases (5.6%) underwent re-revision; 11 involved the femoral component and 9 the tibial component. Tibial augments were significantly more frequent in cases requiring re-revision. Metaphyseal sleeves were less frequently used in cases requiring re-revision, although this difference did not reach statistical significance. Radiographic assessment using the D'Amato score showed statistically significant differences between groups for both femoral and tibial components. Tibial augments were associated with a higher rate of re-revision following rTKA, likely reflecting increased reconstruction. Metaphyseal sleeves showed lower failure rates, although this did not reach statistical significance. Our study highlights the importance of achieving adequate reconstruction and stable fixation in revision TKA.