Causes of Revision of Total Knee Arthroplasties in a Tertiary Hospital in Brazil

Objective  To identify the causes of revision of total knee arthroplasty in a referral center in Brazil. Methods  This is a case series, with 80 patients undergoing revision surgery for total knee arthroplasty (RTKA) at a referral center for knee surgery, between August 2019 and November 2021, with a mean age of 69.6 years. Of these patients, 60.23% were female and 39.77% were male. The average body mass index (BMI) was 30.23 kg/m ² . The causes of TKA failure were defined as: periprosthetic infection according to the 2018 International Consensus Meeting criteria, ligament instability, range of motion limitation, periprosthetic fracture, malalignment, aseptic loosening, pain due to non-replacement of the patellar cartilage, polyethylene wear, fracture of implants, insufficiency of the extensor mechanism. Results  Periprosthetic joint infection (PJI) was the main cause of revision total knee arthroplasty (TKA), corresponding to 47.73% of cases. Aseptic loosening of one or more components represented the second most frequent reason for TKA failure, accounting for 35.23% of revisions. Range of motion limitation represented the third most frequent cause, accounting for 5.68% of surgeries. Instability was the fourth most frequent reason for RTKA, occurring in 4.55% of patients. The other causes of revision were: periprosthetic fracture (3.41%), failure due to rupture of the extensor mechanism (2.27%), and pain attributed to non-replacement of the patellar cartilage (1.14%). Conclusions  Periprosthetic joint infection was the most frequent cause of TKA revision in our series. Other reasons for TKA failures were, in descending order: aseptic loosening, limited range of motion, and instability.