Why are revision knee replacements failing?

Aim: The number of knee revisions worldwide has been steadily increasing. While being complex and expensive operations, a high percentage of knee revisions fail early. This study was conducted to evaluate the causes of failure of revision knee replacements.

Patients And Methods: This study retrospectively evaluated 95 patients following knee revision surgery and who underwent further knee revision operations. Indications for index revision as well as the reason for re-revision were recorded. Follow-up was from 30 to 97 months (mean 62 months).

Results: The main cause of failure of revision knee replacements was infection (31 of 95, 32.6%) followed by aseptic loosening (30.5%). Indications for re-revision were instability in 12.6%, persistent stiffness in 10.5%, ongoing pain in 7.3%, extensor mechanism problems in 5.2%, and suspected metal allergy in one.

Conclusion: Infection and loosening continue to be the main reasons for failure of knee revisions. Improving outcomes for infection management and improved fixation methods may help reduce failed knee revisions.