Abstract:Objective To explore the main causes of failure after total knee arthroplasty (TKA).Methods A retrospective analysis was performed on 280 patients who underwent knee revision surgeries from January 2012 to December 2021,with 298 knees included.A 2-year interval between initial TKA and revision was considered to be the demarcating point between early and late stage.Less than 2 years was considered to be early stage revision,and more than or equal to 2 years was considered to be late stage revision.There were 144 cases of early revision,154 cases of late revision and 29 cases of multiple revision.There were 76 males and 204 females.The average age was (67.5±9.4) years,ranging from 26 to 87 years.The revision cause was infection in 171 cases,aseptic loosening in 75 cases,periprosthesis fracture in 13 cases,knee instability in 15 cases,and polyethylene gasket wear in 4 cases.There were 4 cases of joint stiffness,12 cases of prosthesis dislocation and 4 cases of patellofemoral joint problems.Age,body mass index (BMI),American society of anesthesiologists (ASA) score,ageadjusted charlson comorbidity index,and adjusted charlson comorbidity index were compared in early revision,late revision,and multiple revision.aCCI),and the proportion of renovation reasons.Results Of the 280 patients,298 TKA revisions were made,and 18 patients underwent bilateral knee revision (36 underwent surgery) during the study period.In 298 cases,the highest proportion of revision was periprosthesis infection (overall 57.4%,first early revision 76.4%,first late revision 39.6%,multiple revision 72.4%),followed by aseptic loosening (overall 25.2%,first early revision 8.3%,first late revision 40.9%,and subsequent revision 20.7%).In the primary revision group,76.4% of the patients underwent early revision due to infection.The mean age of patients was (67.5±9.4) years,most (76.2%) had relatively serious systemic disease (ASA Grade Ⅱ),and the mean BMI of (26.3±4.2) kg/m2 met the criteria for overweight.204 patients (72.1%) were female,nearly treble as many as male patients.Among the 29 patients who had previously undergone revision surgery from 1 to 6,infection remained the primary reason for revision in 72.4% of these patients.Conclusion Regardless of the initial revision or multiple revisions,infection is still the most important failure mechanism after the initial TKA.We should pay more attention to the early follow-up observation after the initial TKA to timely detect and reduce the revision rate.
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