JOA - 2026-08-01 - Systematic Review; Journal Article; Meta-Analysis
Etiology of Failure in Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
Lakpriya S, De C, Tahir M, Sanka SK, Pierce TP, Gwam C
Topics
Key Takeaway
Among 39,723 revision TKAs, the re-revision rate was 13.5%, with PJI accounting for 27.5% of failures—nearly double the rate of instability (13.6%) or aseptic loosening (12.8%).
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Summary
This systematic review and meta-analysis examined re-revision rates and failure etiologies across 16 studies (2014–2025) encompassing 39,723 revision TKAs. The pooled re-revision rate was 13.5%; PJI was the leading cause of failure at 27.5% (95% CI 26.4–28.8), followed by instability at 13.6%, aseptic loosening at 12.8%, arthrofibrosis at 9.4%, unexplained pain at 8.0%, and periprosthetic fracture at 7.6%. Substantial heterogeneity was present across included studies.
Key Limitation
Substantial heterogeneity across the 16 included studies without stratification by constraint level, prior revision indication, or time to re-revision prevents identification of modifiable surgical factors driving the 13.5% re-revision rate.
Original Abstract
BACKGROUND
Revision total knee arthroplasty (TKA) remains a burden and will continue to increase in incidence. The purpose of this systematic review and meta-analysis was to analyze the current revision rates and most common etiologies of failure of revision TKA.
METHODS
A comprehensive search of multiple electronic databases (PubMed, CINAHL Plus, EMBASE, and SCOPUS) was performed for all articles pertaining to this topic from 2014 to 2025. A total of 16 studies were included in this study. Study characteristics, patient demographics, rate of re-revision, and etiology for revision failures were extracted from each study.
RESULTS
Among 39,723 revision arthroplasties, the re-revision rate for this cohort was 13.5% (n = 5,350 revisions). The most common etiologies for revision failure were periprosthetic joint infection (27.5%; 95% confidence interval [CI], 26.4 to 28.8), instability (13.6%; 95% CI, 12.7 to 14.5), aseptic loosening (12.8%; 95% CI, 11.9 to 13.7), arthrofibrosis (9.4%; 95% CI, 8.5 to 10.4), unexplained pain (8.0%; 95% CI, 7.1 to 8.9), and periprosthetic fracture (7.6%; 95% CI, 6.8 to 8.5). There was substantial heterogeneity found among the studies, with very few showing publication bias.
CONCLUSIONS
Our revision failure rate of 13.5% is similar to other studies. The most common etiologies for revision TKA failure were infection, instability, and aseptic loosening. Future studies should focus on patient- and surgery-specific factors that could maximize the safety and efficacy of revision TKA.