Failure After Modern Total Knee Arthroplasty: A Prospective Study of 18,065 Knees

Abstract

Background: We sought is to determine the mechanism of failure among primary total knee arthroplasties (TKAs) performed at a single high-volume institution by asking the following research questions: (1) What are the most common failure modes for modern TKA designs? and (2) What are the preoperative risk factors for failure following primary TKA?

Methods: From May 2007 to December 2012, 18,065 primary TKAs performed on 16,083 patients at a single institution were recorded in a prospective total joint arthroplasty registry with a minimum of 5-year follow-up. We retrospectively reviewed patient charts to determine a cause of failure for primary TKAs. A cox proportional hazard model was used to determine the risk of revision surgery following primary TKA.

Results: The most common reasons for failure within 2 years after TKA were infection and stiffness. The multivariable regression identified the following preoperative risk factors for TKA failure: history of drug abuse (hazard ratio [HR] 4.68; P = 0.03), deformity/mechanical preoperative diagnosis (HR 3.52; P < .01), having a constrained condylar knee implant over posterior-stabilized implant (HR 1.99; P < .01), post-traumatic/trauma preoperative diagnosis (HR 1.78; P = .03), and younger age (HR 0.61; P < .01) CONCLUSION: These findings add to the growing data that primary TKAs are no longer failing from polyethylene wear-related issues. This study identified preoperative risk factors for failure of primary TKAs, which may be useful information for developing strategies to improve outcomes following TKA.

Keywords: arthrofibrosis; aseptic loosening; instability; osteolysis; primary total knee arthroplasty failure.

Figure 1

Flow diagram of patients included in the study

Figure 2

Kaplan-Meier survival graph for reasons for failure. Log-rank test- nonparametric test that compares survival distributions. A p<0.05 indicates there is a difference between survival curves.

Figure 3

Kaplan-Meier survival graph for preoperative diagnosis. Log-rank test- nonparametric test that compares survival distributions. A p<0.05 indicates there is a difference between survival curves.