[Why are we revising our primary knee arthroplasties? An evaluation of the causes for revision of primary knee arthroplasties over a five-year period (2018-2022)].

Abstract

Introduction: the progressive increase in the volume of primary knee arthroplasty surgery is leading in parallel to an increase in revision surgeries, and this trend is expected to continue in the coming decades.

Material and methods: a retrospective observational study with 203 interventions in 201 patients with knee arthroplasty revision surgery at our center between 2018-2022, including the variables age, sex, body mass index, primary implant, time until revision surgery, mechanical alignment of the primary implant, cause of revision, revision implant, and need for secondary revision.

Results: the average age of the patients was 73.8 years (70% were women). The average time from primary surgery to revision was 58.7 months. The main cause of revision was aseptic loosening (37.9%). Eighty-three (34.9%) patients required an early revision (on average, in 12.7 months), with instability being the main cause in this subgroup (36.1%). Twenty-four (11.8%) patients required an additional revision, also mainly due to instability (33.3%), with a younger average age (66.9 years). The most common surgical approach was complete replacement (70%).

Conclusions: knee arthroplasty revision surgery in our environment is determined by different patterns depending on the chronology. Joint stability is the main determinant of revision in the first two years, while aseptic loosening seems to predominate in the long term, with infection in the background. Revision of primary knee arthroplasty remains to be a surgical challenge, as 11.8% of patients required an additional revision surgery, especially in younger patients.