Revision Total Knee Arthroplasty: Epidemiology and Causes

  • E. Carlos Rodríguez-Merchán
  • Carlos A. Encinas-Ullán
  • Primitivo Gómez-Cardero


Aseptic loosening (36%), periprosthetic joint infection (22%), and periprosthetic fracture (14%) are the most frequent causes for revision after total knee arthroplasty (TKA). Other less common causes of revision TKA (RTKA) are instability (7%), pain (6%), polyethylene wear (5%), restriction of motion (arthrofibrosis) (4%), extensor mechanism insufficiency (4%), mechanical defect (1.5%), and metal allergy (0.5%). Revision surgery for failed TKA continues to pose a considerable burden for health-care systems. The highest frequency of RTKA is in white patients younger than 40 years of age (27%). African-Americans (18%), other races (8%), and Hispanics (16.5%) have the highest frequency of revision in the 40- to 64-year age range. Among Asians (4%) and Native Americans (10%), revision frequency is highest in patients older than 65 years. Risk factors for RTKA are obesity, diabetes mellitus, chronic obstructive pulmonary disease, opioid use, drug abuse (cocaine, cannabis, opioids, sedatives/hypnotics/anxiolytics, amphetamines, alcohol), smoking, metal allergy (nickel), preoperative valgus deformity (valgus deformity has a 2.1-fold higher risk of RTKA compared with varus deformity), immediate postoperative mechanical axis (>3° deviation from neutral alignment), and strong physical activity.


Revision Total knee arthroplasty Epidemiology Causes Risk factors 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • E. Carlos Rodríguez-Merchán
    • 1
  • Carlos A. Encinas-Ullán
    • 1
  • Primitivo Gómez-Cardero
    • 1
  1. 1.Department of Orthopedic Surgery“La Paz” University HospitalMadridSpain

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