Published online Apr 18, 2018. doi: 10.5312/wjo.v9.i4.60
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
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.
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.