What Are the Causes of Revision Total Knee Arthroplasty in Japan?
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.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.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
- 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: http://www.njrcentre.org.uk/njrcentre/ReportsPublicationsandMinutes/Annualreports/Archivedannualreports/tabid/87/5thAnnual.pdf. Accessed April 27, 2012.
- 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
- 14.Ministry of Health, Labour and Welfare. National Health and Nutrition Examination Survey 2008. Available at: http://www.mhlw.go.jp/bunya/kenkou/eiyou/h22-houkoku.html. Accessed September 19, 2012.
- 18.Swedish Knee Arthroplasty Register. SKAR Annual Report 2011. Available at: http://www.knee.nko.se/english/online/uploadedFiles/115_SKAR2011_Eng1.0.pdf. Accessed April 27, 2012.
- 20.YANO Research. Orthopedic Medical Device Market in Japan 2009. Tokyo, Japan: Yano Research Institute Ltd; 2009:77.Google Scholar
- 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.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