JOA - 2026-08-11 - Journal Article
Isolated versus Full-Component Revision Total Knee Arthroplasty for Aseptic Loosening: Systematic Review and Meta-Analysis.
Sheth N, McCall M, Hrudka B, Syed O, Brito M, Seilern J, Reardon E, Perry R, Premkumar A, Wilson JM
Topics
Key Takeaway
Isolated component revision TKA yields re-revision rates statistically equivalent to full-component revision (OR 1.36, 95% CI 0.96–1.95, P=0.094) while significantly reducing operative time (SMD 2.85, P<0.001).
Summary Depth
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Summary
This systematic review and meta-analysis compared isolated versus full-component revision TKA for aseptic loosening across 11 studies (mean age 66 years, 65.8% female). Re-revision rates for all indications (OR 1.36, P=0.094), aseptic loosening (OR 0.76, P=0.42), and PJI (OR 1.23, P=0.64) were statistically equivalent between groups. Isolated revision significantly reduced operative time (SMD 2.85, P<0.001) with similar postoperative ROM.
Key Limitation
Total patient-level sample size is not reported, and the extreme operative time heterogeneity (I²=98.8%) combined with reliance on only two studies for blood loss data limits confidence in the morbidity-reduction conclusions.
Original Abstract
BACKGROUND
Aseptic loosening after total knee arthroplasty (TKA) is a challenging complication. Outcomes regarding an isolated versus full component revision TKA (rTKA) are not well summarized in the literature. To address this, we conducted a systematic review of the literature regarding this topic along with a meta-analysis to clarify inconsistent conclusions in the literature.
METHODS
We used Embase.com, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov to search from their inception to September 17, 2025. A bias quality assessment was conducted for each study included. There were 11 studies that were included in the final analysis to assess for and compare complications, implant failures, and functional results between isolated versus full component rTKA. Across 11 studies (median cases: 164; mean age: 66 years; 65.8% women)
RESULTS
Isolated and full component rTKA demonstrated comparable rates of re-revision for all indications (odds ratio (OR): 1.36, 95% confidence interval (CI) 0.96 to 1.95, P = 0.094, I 2 = 23.5%), including aseptic loosening (OR: 0.76, 95% CI 0.40 to 1.47, P = 0.42, I 2 = 7.0%) and periprosthetic joint infection (OR: 1.23, 95% CI 0.52 to 2.92, P = 0.64, I 2 = 7.5%). The isolated component rTKA showed significantly reduced operative time (Standardized Mean Difference = 2.85, 95% CI 1.47 to 4.23, P < 0.001, I 2 = 98.8%), and two studies reported lower intraoperative blood loss, while postoperative range of motion was similar between approaches without consistent differences.
CONCLUSIONS
In this systematic review and meta-analysis, isolated component revision demonstrated outcomes comparable to full component revision. These findings support the idea that when components are well-fixed and compatible, isolated component revision may serve as a less morbid option for rTKA. Additional prospective and longer-term studies are required to corroborate these findings.
LEVEL OF EVIDENCE
I.