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World J Orthop. Apr 18, 2018; 9(4): 60-64
Published online Apr 18, 2018. doi: 10.5312/wjo.v9.i4.60
Why total knees fail-A modern perspective review
Zachary C Lum, Alvin K Shieh, Lawrence D Dorr
Zachary C Lum, Alvin K Shieh, Department of Orthopaedic Surgery, Davis Medical Center, University of California, Sacramento, CA 95817, United States
Lawrence D Dorr, Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA 90033, United States
Author contributions: All authors contributed to the manuscript.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zachary C Lum, MD, Surgeon, Department of Orthopaedic Surgery, Davis Medical Center, University of California, 4860 Y Street, Suite 3800, Sacramento, CA 95817, United States. zacharylum@gmail.com
Telephone: +1-916-7342807
Received: January 4, 2018
Peer-review started: January 5, 2018
First decision: January 31, 2018
Revised: March 6, 2018
Accepted: April 1, 2018
Article in press: April 1, 2018
Published online: April 18, 2018
Abstract

Historically, the most common mechanism of total knee arthroplasty (TKA) failures included aseptic loosening, instability and malalignment. As polyethylene production improved, modes of failure from polyethylene wear and subsequent osteolysis became less prevalent. Newer longitudinal studies report that infection has become the primary acute cause of failure with loosening and instability remaining as the overall greatest reasons for revision. Clinical database and worldwide national registries confirm these reports. With an increasing amount of TKA operations performed in the United States, and with focus on value-based healthcare, it is imperative to understand why total knees fail.

Keywords: Total knee arthroplasty failure mechanism, Total knee arthroplasty failure mode, Revision total knee arthroplasty, Periprosthetic joint infection, Aseptic loosening total knee, Total knee arthroplasty instability

Core tip: With increasing number of revision total knee arthroplasty (TKAs) being performed, tighter control on healthcare costs and value based care may occur. Surgeons are tasked with the responsibility to avoid risk factors for revision TKA. Newer longitudinal studies report that infection has become the primary acute cause of failure with loosening and instability remaining as the overall greatest reasons for revision. The surgeon must be aware of the risk factors and preventative measures for these failure modes, including preoperative management, surgical techniques and enhanced materials.