Causes of Failure in Total Knee Arthroplasty
Rapeepat Narkbunnam MD, FRCOST*,
Keerati Chareancholvanich MD*
Affiliation :
* Department of Orthopaedics Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : The number of primary total knee replacement procedures has rapidly increased worldwide because of the high
success rates. The incidence of failure of total knee replacements has concurrently increased. Determining the causes of
failure is very important for devising treatment and plan for future prevention strategies.
Material and Method: A retrospective study was done with patients who underwent revised total knee replacements in Siriraj
Hospital between September 2003 and March 2009. Patient demographic data, laboratory tests, radiographic studies, and
intra-operative findings were used to categorize the causes of failure.
Results : One hundred eighty nine patients (31 male, 158 female) were included in the present study. The average age was 70.8
years. The average survival time after surgery was 6.42 years (ranging from 1 month to 22 years). The major causes of
failure included aseptic loosening (52%), polyethylene wear (43%), and infection (31%). Infection (61%) was found in more
than half the cases of early failure (< 3 years). Most cases of late failure (> 3 years) were due to aseptic loosening (74%),
polyethylene wear (68%), and infection (14%). Male sex and early failure were strongly associated with failure secondary to
infection, with odds ratios 4.5 and 8.8, respectively.
Conclusion : There are different causes of early and late failure. The major cause of early failure was infection, while aseptic
loosening and polyethylene wear played major roles in late failure. The number of failures due to infection was higher than
observed from previous studies. Identification of the causes of failure of total knee replacement surgery from the same country
or region will be useful for devising plans to manage and prevent failure in future surgeries.
Keywords : Causes, Failure, Knee joint, Arthroplasty, Knee replacement, Knee prosthesis, Infection
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