Failure of Primary Total Knee Arthroplasty: Analysis of Causes in 55 Patients

Background and Purpose: Primary total knee arthroplasty (TKA) is usually performed patients with osteoarthritis or rheumatic arthritis. As the number of primary TKA procedures and life expectancy of the population increases, the failure rate of TKA is also increasing. The purpose of this study was to evaluate the causes of failed TKA. Material and Methods: We analyzed 59 cases of failed primary TKA in 55 patients (46 women and 9 men). The patients were divided into 2 groups based on the duration between the index TKA operation and revision surgery: Group 1 was early failure at less than 2 years, and group 2 was late failure at more than 2 years. The patients' complete history was obtained before revision TKA, and they underwent physical examination and weight-bearing radiography of the knee. In addition, surgical findings were reviewed. Results: Group 1 included 13 patients with failed TKA due to infection (n=8, 61.5%), polyethylene wear (n=4, 30.7%), or an overstuffed prosthesis (n=1, 7.6%). Group 2 included 46 patients in whom failure was due to polyethylene wear (n=39, 84.8%), late infection (n=5, 10.9%), or malalignment of the femoral component or arthrofibrosis (n=1 each, 2.2%). Conclusion: Infection is the most common cause of early failure of TKA, and polyethylene wear is the most common cause of late failure of TKA.