Reoperation After Total Knee Arthroplasty

The specific incidence of and causes for reoperation after total knee arthroplasty (TKA) continue to change with time. In the early experience with hinge and condylar knees, reoperations were most frequently required for prosthetic loosening, knee instability, and sepsis. Thirty-five years ago, patellofemoral complications accounted for up to 50% of reoperations. With improved prosthetic designs and better surgical techniques, reoperations became less frequent. In the decade between 2000 and 2010, polyethylene wear (often associated with lysis) was a leading cause of failure. With improvements in polyethylene fabrication, sterilization methods, and modular locking mechanisms, this failure mode has become less common. Infection, loosening, and instability remain the most frequent reasons for revision after total knee arthroplasty with infection predominating early and prosthetic loosening and instability becoming more frequent over time. Polyethylene wear is still a factor but is occurring with much less frequency than it did in prior years.