Clinical Orthopaedics and Related Research®

, Volume 472, Issue 1, pp 316–326 | Cite as

Causes, Risk Factors, and Trends in Failures After TKA in Korea Over the Past 5 Years: A Multicenter Study

  • In Jun Koh
  • Woo-Shin Cho
  • Nam Yong Choi
  • Tae Kyun Kim
  • The Kleos Korea Research Group
Clinical Research



Failure after total knee arthroplasty (TKA) may be related to emerging technologies, surgical techniques, and changing patient demographics. Over the past decade, TKA use in Korea has increased substantially, and demographic trends have diverged from those of Western countries, but failure mechanisms in Korea have not been well studied.


We determined the causes of failure after TKA, the risk factors for failure, and the trends in revision TKAs in Korea over the last 5 years.


We retrospectively reviewed 634 revision TKAs and 20,234 primary TKAs performed at 19 institutes affiliated with the Kleos Korea Research Group from 2008 to 2012. We recorded the causes of failure after TKA using 11 complications from the standardized complication list of The Knee Society, patient demographics, information on index and revision of TKAs, and indications for index TKA. The influences of patient demographics and indications for index TKA on the risk of TKA failure were evaluated using multivariate regression analysis. The trends in revision procedures and demographic features of the patients undergoing revision TKA over the last 5 years were assessed.


The most common cumulative cause of TKA failure was infection (38%) followed by loosening (33%), wear (13%), instability (7%), and stiffness (3%). However, the incidence of infections has declined over the past 5 years, whereas that of loosening has increased and exceeds that of infection in the more recent 3 years. Young age (odds ratio [OR] per 10 years of age increase, 0.41; 95% confidence interval [CI], 0.37–0.49) and male sex (OR, 1.88; 95% CI, 1.42–2.49) were associated with an increased risk of failure. The percentage of revision TKAs in all primary and revision TKAs remained at approximately 3%, but the annual numbers of revision TKAs in the more recent 3 years increased from that of 2008 by more than 23%.


Despite a recent remarkable increase in TKA use and differences in demographic features, the causes and risk factors for failures in Korea were similar to those of Western countries. Infection was the most common cause of failure, but loosening has emerged as the most common cause in more recent years, which would prompt us to scrutinize the cause and solution to reduce it.

Level of Evidence

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.


Total Knee Arthroplasty Unicompartmental Knee Arthroplasties Primary Total Knee Arthroplasty Revision Total Knee Arthroplasty Primary TKAs 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Chong Bum Chang MD (Seoul National University Bundang Hospital, Seongnam, Korea); Sung Ryong Shin MD, Sang Bum Kim MD, Jong Won Kim MD, Duck Hyun Choi MD, Ki Hyun Jo MD, and Nong Kyoum Ahn MD (Himchan Hospital, Seoul, Korea); Yong Bum Park MD, and Sug Jun Kim MD (KS Hospital, Seoul, Korea); Gwang Chul Lee MD (Chosun University Hospital, Gwangju, Korea); and Yong Chan Kim MD, and Chul Jun Choi MD (Yonsei Sarang Hospital, Bucheon, Korea) for their assistance in furnishing data. We also thank Seongeun Byun MD (Asan Medical Center, Seoul, Korea); Jae-Woong Yoon MD, and Kyo-Sun Lee MD (St Paul’s Hospital, Seoul, Korea); Hyuk Park MD (Chonbuk National University Hospital, Kunsan, Korea); Jong-Min Park MD (St Vincent’s Hospital, Suwon, Korea); Ho Hyun Won MD, and Yeon Gwi Kang MS (Seoul National University Bundang Hospital, Seongnam, Korea); Bum Yong Park MD (Seoul St Mary’s Hospital, Seoul, Korea); Jun Gyu Lee MD (Konkuk University Medical Center, Seoul, Korea); Hye Sun Ahn MS (Himchan Hospital, Seoul, Korea); and Seon Hwa Lee MS (Yonsei Sarang Hospital, Bucheon, Korea) for their assistance in data collection.


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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • In Jun Koh
    • 1
    • 2
  • Woo-Shin Cho
    • 3
  • Nam Yong Choi
    • 2
    • 4
  • Tae Kyun Kim
    • 5
    • 6
  • The Kleos Korea Research Group
  1. 1.Department of Orthopaedic SurgeryUijeongbu St Mary’s HospitalGyeonggi-doKorea
  2. 2.Department of Orthopaedic SurgeryCatholic University of Korea College of MedicineSeoulKorea
  3. 3.Department of Orthopaedic Surgery, Asan Medical CenterUlsan University School of MedicineSeoulKorea
  4. 4.Department of Orthopaedic SurgerySt Paul’s HospitalSeoulKorea
  5. 5.Joint Reconstruction CenterSeoul National University Bundang HospitalGyeonggi-doKorea
  6. 6.Department of Orthopaedic SurgerySeoul National University College of MedicineSeoulKorea

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