Modes of failure of total knee arthroplasty: registries and realities

Revision knee arthroplasty places a major strain on the health care system and is associated with high rates of complications, readmissions, and reoperations. Determining the modes of failure of total knee arthroplasty (TKA) preoperatively is essential for a successful revision procedure. Nationwide arthroplasty registries have served as reliable quality control instruments and as data sources of clinical studies that can potentially help guide the investigation of a failed TKA. Modes of failure vary according to the setting of the procedure (primary vs revision arthroplasty) and the prosthesis level of constraint. This article reviews the most prevalent modes of failure of primary and revision TKA, and further quantifies rates and specific modes of failure of bicruciate retaining, posterior cruciate retaining, posterior stabilizing, varus-valgus constrained, and hinged implants.