Symposium: Special Considerations for TKA in Asian Patients

Clinical Orthopaedics and Related Research®

, Volume 471, Issue 5, pp 1533-1538

First online:

What Are the Causes of Revision Total Knee Arthroplasty in Japan?

  • Yasuhiko KasaharaAffiliated withDepartment of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine
  • , Tokifumi MajimaAffiliated withDepartment of Joint Replacement and Tissue Engineering, Hokkaido University Graduate School of Medicine Email author 
  • , Shoichi KimuraAffiliated withDepartment of Orthopaedic Surgery, Eniwa Hospital
  • , Osamu NishiikeAffiliated withDepartment of Orthopaedic Surgery, Kushiro-Sanjikai HospitalDepartment of Orthopaedic Surgery, Abashiri Kousei Hospital
  • , Jun UchidaAffiliated withDepartment of Orthopaedic Surgery, Hakodate Central General Hospital

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There is limited information regarding the cause of revision TKA in Asia, especially Japan. Owing to differences in patient backgrounds and lifestyles, the modes of TKA failures in Asia may differ from those in Western countries.


We therefore determined (1) causes of revision TKA in a cohort of Japanese patients with revision TKA and (2) whether patient demographic features and underlying diagnosis of primary TKA are associated with the causes of revision TKA.


We assessed all revision TKA procedures performed at five major centers in Hokkaido from 2006 to 2011 for the causes of failures. Demographic data and underlying diagnosis for index primary TKA of the revision cases were compared to those of randomly selected primary TKAs during the same period.


One hundred forty revision TKAs and 4047 primary TKAs were performed at the five centers, indicating a revision burden of 3.3%. The most common cause of revision TKA was mechanical loosening (40%) followed by infection (24%), wear/osteolysis (9%), instability (9%), implant failure (6%), periprosthetic fracture (4%), and other reasons (8%). The mean age of patients with periprosthetic fracture was older (77 versus 72 years) and the male proportion in patients with infection was higher (33% versus 19%) than those of patients in the primary TKA group. There was no difference in BMI between primary TKAs and any type of revision TKA except other causes.


The revision burden at the five referral centers in Hokkaido was 3.3%, and the most common cause of revision TKA was mechanical loosening followed by infection. Demographic data such as age and sex might be associated with particular causes of revision TKA.