What are the causes of failure after total knee arthroplasty?

Abstract

Purpose

This study aimed to review the causes of failure after total knee arthroplasty (TKA), focusing on the causes of revision and persistent pain.

Methods

A literature search was conducted in the databases of PubMed, Cochrane Library, and Google Scholar for articles published before October 4, 2022. In addition, registry data from 11 countries were obtained from national registry archives.

Results

National registry data and recent articles show that aseptic loosening, infection, instability, patellofemoral complication, and pain are major overall causes of TKA revisions. The most common etiologies of TKA revisions were aseptic loosening in six countries and infection in four countries. In contrast, polyethylene wear has become one of the minor reasons for revision, although it used to be one of the major causes of revision. Additionally, various causes of persistent pain include improper component placement, oversizing, patellofemoral overstuffing, ligament imbalance, elevated joint lines, kinematic abnormalities, and preoperative psychological factors such as catastrophizing state and central sensitization of pain.

Conclusions

With the evolution of surgical techniques and prosthetic designs, a paradigm shift in the etiology of failure mechanisms after TKA might have occurred. However, the number of patients with TKA failure suffering from persistent pain and requiring revision is increasing. Thus, orthopedic surgeons must understand the current situations of TKA failures to improve clinical outcomes and reduce post-TKA dissatisfaction.