Analysis of knee arthroplasty revision causes

Introduction Existing discrepancies in knee arthroplasty registries regarding the definition of indications for  revision TKA lead to confusion related to the identification of the leading pathology. Many works indicate not only one but several reasons for revision which makes comparison difficult. Therefore, the issue of  categorizing indications for revision TKA is a weak point of the available registries and of any large retrospective series.

Purpose To systematize the etiology of pathological conditions leading to revision knee arthroplasty.

Materials and methods The study included 361 revision knee arthroplasties. A comparative analysis of the etiology of complications of primary arthroplasty was carried out with data from national arthroplasty registries and clinical studies.

Results The main indications for revision knee arthroplasty were infection in 48.2 % of cases (174/361), aseptic implant instability (osteolysis) in 38.2 % (138/361), and instability of the ligamentous apparatus in 4.2 % (15/361). In 98 cases (27.1 %), only one type of complication was identified, and in 263 (85.2 %) more than one. Infection prevailed among early complications (126/234, 54 %) and aseptic loosening (osteolysis) (69/127, 54 %) predominated among late complications.

Discussion In our opinion, the indications for revision arthroplasty can be divided into three main etiological groups: periprosthetic infection (group I); conditions associated with a response to polyethylene wear products (osteolysis) (group 2); and biomechanical disorders, which include spatial malposition, incorrect implant sizes and all types of instability (group 3).

Conclusion Our systematization of revision arthroplasty causes can help in further research and will be useful in creating a national registry of arthroplasties in Russia.

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