Re-revision Total Knee Arthroplasty: Causes, Risk Factors and Results

Document Type : CURRENT CONCEPTS REVIEW

Author

Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain

10.22038/abjs.2024.75456.3490

Abstract

The rate of re-revision total knee arthroplasty (TKA) ranges between 4% and 10%, depending on the 
cause of the procedure. Periprosthetic joint infection (PJI) and periprosthetic fracture are the main 
causes of re-revision TKA. The likelihood of implant survival of re-revision TKA diminishes with each 
subsequent revision, with PJI being the main cause of multiple revisions. Acute early asep tic revision 
TKA (within 90 days of surgery) involves a high risk of re-revision at 2 years and a high risk of 
subsequent PJI. The use of antibiotic-loaded cement is associated with lower risk of re-revision. 
Patients younger than 50 years experiencing aseptic revision TKA have a 1 in 3 risk of re-revision. 
Patients revised for instability or having prior TKA revisions have the highest risk of re -revision at 10 
years. Patients younger than 55 years experiencing revision TKA have a 5 -year revision-free survival 
of 80%.
 Level of evidence: III

Keywords

Main Subjects


1. Postler A, Lützner C, Beyer F, Tille E, Lützner J. Analysis of 
total knee arthroplasty revision causes. BMC Musculoskelet 
Disord. 2018; 19(1):55. doi: 10.1186/s12891-018-1977-y.
2. Halder AM, Gehrke T, Günster C, et al. Low hospital volume 
increases re-revision rate following aseptic revision total 
knee arthroplasty: an analysis of 23,644 cases. J Arthroplasty. 
2020; 35(4):1054-1059. doi: 10.1016/j.arth.2019.11.045. 
3. Bonanzinga T, Akkawi I, Zahar A, Gehrke T, Haasper C, 
Marcacci M. Are metaphyseal sleeves a viable option to treat 
bone defect during revision total knee arthroplasty? A 
systematic review. Joints. 2019; 7(1):19-24. doi: 10.1055/s0039-1697611. 
4. Bongers J, Jacobs AME, Smulders K, van Hellemondt GG, Goosen 
JHM. Reinfection and re-revision rates of 113 two-stage 
revisions in infected TKA. J Bone Jt Infect. 2020; 5(3):137-
144. doi: 10.7150/jbji.43705.
5. Reina N, Salib CG, Pagnano MW, Trousdale RT, Abdel MP, Berry 
DJ. Varus-valgus constrained implants with a mobile-bearing 
articulation: results of 367 revision total knee arthroplasties. 
J Arthroplasty. 2020; 35(4):1060-1063. doi: 
10.1016/j.arth.2019.11.023. 
6. Meyer JA, Zhu M, Cavadino A, Coleman B, Munro JT, Young SW. 
Infection and periprosthetic fracture are the leading causes of 
failure after aseptic revision total knee arthroplasty. Arch 
Orthop Trauma Surg. 2021; 141(8):1373-1383. doi: 
10.1007/s00402-020-03698-8. 
7. Levent A, Suero EM, Gehrke T, Bakhtiari IG, Citak M. Risk 
factors for aseptic loosening in complex revision total knee 
arthroplasty using rotating hinge implants. Int Orthop. 2021; 
45(1):125-132. doi: 10.1007/s00264-020-04878-2. 
8. Klasan A, Magill P, Frampton C, Zhu M, Young SW. Factors 
predicting repeat revision and outcome after aseptic revision 
total knee arthroplasty: results from the New Zealand Joint 
Registry. Knee Surg Sports Traumatol Arthrosc. 2021; 
29(2):579-585. doi: 10.1007/s00167-020-05985-8.
9. Chalmers BP, Syku M, Gausden EB, Blevins JL, Mayman DJ, 
Sculco PK. Contemporary distal femoral replacements for 
supracondylar femoral fractures around primary and 
revision total knee arthroplasties. J Arthroplasty. 2021; 
36(7S):S351-S357. doi: 10.1016/j.arth.2020.12.037.
10. Shen TS, Gu A, Bovonratwet P, Ondeck NT, Sculco PK, Su EP. 
Patients who undergo early aseptic revision TKA within 90 
days of surgery have a high risk of re-revision and infection at 
2 years: a large-database study. Clin Orthop Relat Res. 2022; 
480(3):495-503. doi: 10.1097/CORR.0000000000001985. 
11. Oganesyan R, Klemt C, Esposito J, Tirumala V, Xiong L, Kwon 
YM. Knee arthroscopy prior to revision TKA is associated 
with increased re-revision for stiffness. J Knee Surg. 2022; 
35(11):1223-1228. doi: 10.1055/s-0040-1722662. 
12. Bingham JS, Bukowski BR, Wyles CC, Pareek A, Berry DJ, 
Abdel MP. Rotating-hinge revision total knee arthroplasty for 
treatment of severe arthrofibrosis. J Arthroplasty. 2019; 
34(7S):S271-S276. doi: 10.1016/j.arth.2019.01.072.
13. Chalmers BP, Pallante GD, Sierra RJ, Lewallen DG, Pagnano 
MW, Trousdale RT. Contemporary revision total knee 
arthroplasty in patients younger than 50 years: 1 in 3 risk of 
re-revision by 10 years. J Arthroplasty. 2019; 34(7S):S266-
S270. doi: 10.1016/j.arth.2019.02.001.
14. Chalmers BP, Syku M, Joseph AD, Mayman DJ, Haas SB, 
Blevins JL. High rate of re-revision in patients less than 55 
years of age undergoing aseptic revision total knee 
arthroplasty. J Arthroplasty. 2021; 36(7):2348-2352. doi: 
10.1016/j.arth.2020.12.008. 
15. Xiong L, Klemt C, Yin J, Tirumala V, Kwon YM. Outcome of 
revision surgery for the idiopathic stiff total knee 
arthroplasty. J Arthroplasty. 2021; 36(3):1067-1073. doi: 
10.1016/j.arth.2020.09.005. 
16. Kirschbaum S, Erhart S, Perka C, Hube R, Thiele K. Failure 
analysis in multiple TKA revisions-periprosthetic infections 
remain surgeons' nemesis. J Clin Med. 2022; 11(2):376. doi: 
10.3390/jcm11020376