Clinical Orthopaedics and Related Research®

, Volume 471, Issue 5, pp 1533–1538 | Cite as

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

  • Yasuhiko Kasahara
  • Tokifumi Majima
  • Shoichi Kimura
  • Osamu Nishiike
  • Jun Uchida
Symposium: Special Considerations for TKA in Asian Patients



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.



The authors thank Noriaki Mori MD, PhD (Department of Orthopaedic Surgery, Eniwa Hospital), Jun Nishiike MD (Department of Orthopaedic Surgery, Kushiro-Sanjikai Hospital), Reo Goto MD (Department of Orthopaedic Surgery, Abashiri Kousei Hospital), and Ryo Ando MD (Department of Orthopaedic Surgery, Hakodate Central General Hospital) for collecting cohort data at their hospitals. We also thank Koji Oba PhD for his help in the statistics in this study.


  1. 1.
    Akiyama H, Hoshino A, Iida H, Shindo H, Takakura Y, Miura H, Yamamoto K, Yoshiya S, Hasegawa Y, Shimamura T, Kurosaka M, Otsuka H, Kawanabe K, Kawate K, Harada Y, Nakamura T; Implant Committee, The Japanese Orthopaedic Association. A pilot project for the Japan arthroplasty register. J Orthop Sci. 2012;17:358–369.CrossRefPubMedGoogle Scholar
  2. 2.
    Bozic KJ, Durbhakula S, Berry DJ, Naessens JM, Rappaport K, Cisternas M, Saleh KJ, Rubash HE. Differences in patient and procedure characteristics and hospital resource use in primary and revision total joint arthroplasty: a multicenter study. J Arthroplasty. 2005;20(suppl 3):17–25.CrossRefPubMedGoogle Scholar
  3. 3.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468:45–51.CrossRefPubMedGoogle Scholar
  4. 4.
    Emsley D, Martin J, Newell C, Pickford M, Royall M, Swanson M, van der Meulen J, Charman S, Gregg P, Porter M, Tucker K, Howard P. National Joint Registry for England and Wales: 5th Annual Report. 2008. Available at: Accessed April 27, 2012.
  5. 5.
    Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9–12.PubMedGoogle Scholar
  6. 6.
    Foran JR, Mont MA, Etienne G, Jones LC, Hungerford DS. The outcome of total knee arthroplasty in obese patients. J Bone Joint Surg Am. 2004;86:1609–1615.PubMedGoogle Scholar
  7. 7.
    Hoffmann MF, Jones CB, Sietsema DL, Koenig SJ, Tornetta P 3rd. Outcome of periprosthetic distal femoral fractures following knee arthroplasty. Injury. 2012;43:1084–1089.CrossRefPubMedGoogle Scholar
  8. 8.
    Hossain F, Patel S, Haddad FS. Midterm assessment of causes and results of revision total knee arthroplasty. Clin Orthop Relat Res. 2010;468:1221–1228.CrossRefPubMedGoogle Scholar
  9. 9.
    Jung WH, Jeong JH, Ha YC, Lee YK, Koo KH. High early failure rate of the Columbus posterior stabilized high-flexion knee prosthesis. Clin Orthop Relat Res. 2012;470:1472–1481.CrossRefPubMedGoogle Scholar
  10. 10.
    Kadono Y, Yasunaga H, Horiguchi H, Hashimoto H, Matsuda S, Tanaka S, Nakamura K. Statistics for orthopedic surgery 2006–2007: data from the Japanese diagnosis procedure combination database. J Orthop Sci. 2010;15:162–170.CrossRefPubMedGoogle Scholar
  11. 11.
    Kapadia BH, Johnson AJ, Naziri Q, Mont MA, Delanois RE, Bonutti PM. Increased revision rates after total knee arthroplasty in patients who smoke. J Arthroplasty. 2012;27:1690–1695.e1.Google Scholar
  12. 12.
    Kim HA, Kim S, Seo YI, Choi HJ, Seong SC, Song YW, Hunter D, Zhang Y. The epidemiology of total knee replacement in South Korea: national registry data. Rheumatology. 2008;47:88–91.CrossRefPubMedGoogle Scholar
  13. 13.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.CrossRefPubMedGoogle Scholar
  14. 14.
    Ministry of Health, Labour and Welfare. National Health and Nutrition Examination Survey 2008. Available at: Accessed September 19, 2012.
  15. 15.
    Odland AN, Callaghan JJ, Liu SS, Wells CW. Wear and lysis is the problem in modular TKA in the young OA patient at 10 years. Clin Orthop Relat Res. 2011;469:41–47.CrossRefPubMedGoogle Scholar
  16. 16.
    O’Rourke MR, Callahan JJ, Bozic KJ, Liu SS, Goetz DD, Sullivan PM, Johnston RC. Osteolysis associated with a cemented modular posterior-cruciate-substituting total knee design: five to eight-year followup. J Bone Joint Surg Am. 2002;84:1362–1371.PubMedGoogle Scholar
  17. 17.
    Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award Paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res. 2002;404:7–13.CrossRefPubMedGoogle Scholar
  18. 18.
    Swedish Knee Arthroplasty Register. SKAR Annual Report 2011. Available at: Accessed April 27, 2012.
  19. 19.
    Vessely MB, Whaley AL, Harmsen WS, Schleck CD, Berry DJ. The Chitranjan Ranawat Award. Long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties. Clin Orthop Relat Res. 2006;452:28–34.CrossRefPubMedGoogle Scholar
  20. 20.
    YANO Research. Orthopedic Medical Device Market in Japan 2009. Tokyo, Japan: Yano Research Institute Ltd; 2009:77.Google Scholar
  21. 21.
    Yoshimura N, Muraki S, Oka H, Mabuchi A, En-Yo Y, Yoshida M, Saika A, Yoshida H, Suzuki T, Yamamoto S, Ishibashi H, Kawaguchi H, Nakamura K, Akune T. Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: the research on osteoarthritis/osteoporosis against disability study. J Bone Miner Metab 2009;27:620–628.CrossRefPubMedGoogle Scholar
  22. 22.
    Zhang Y, Xu L, Nevitt MC, Aliabadi P, Yu W, Qin M, Lui LY, Felson DT. Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States: The Beijing osteoarthritis study. Arthritis Rheum. 2001;44:2065–2071.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Yasuhiko Kasahara
    • 1
  • Tokifumi Majima
    • 2
  • Shoichi Kimura
    • 3
  • Osamu Nishiike
    • 4
    • 5
  • Jun Uchida
    • 6
  1. 1.Department of Orthopaedic SurgeryHokkaido University Graduate School of MedicineSapporoJapan
  2. 2.Department of Joint Replacement and Tissue EngineeringHokkaido University Graduate School of MedicineSapporoJapan
  3. 3.Department of Orthopaedic SurgeryEniwa HospitalEniwaJapan
  4. 4.Department of Orthopaedic SurgeryKushiro-Sanjikai HospitalKushiroJapan
  5. 5.Department of Orthopaedic SurgeryAbashiri Kousei HospitalAbashiriJapan
  6. 6.Department of Orthopaedic SurgeryHakodate Central General HospitalHakodateJapan

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