Why Reintervention After Total Knee Arthroplasty Fails? A Consecutive Cohort of 1170 Surgeries

The aim of this study was to analyze why contemporary reintervention after total knee arthroplasty (RiTKA) fails. Between January 2006 and December 2010, from a multicenter cohort of 1170 RiTKAs, we assessed all failures of RiTKA requiring additional surgery. All indications for the index reintervention were included. The minimum follow-up period was 3 years. A total of 192 (16.4%) patients required additional surgery after RiTKA (re-reintervention). The mean follow-up period was 7.7 years. Mean age was 69.2 years. The mean time to re-reintervention was 9.6 months with 90.1% of rTKA failure occurring within the first two years. Infection was the main cause of new surgery after RiTKA (47.9%; n = 92/192). Other causes included extensor mechanism pathology (14.6%), stiffness (13.5%), pain (6.8%), aseptic loosening (5.2%), laxity (5.2%), periprosthetic fracture (3.6%), and wound pathology (3.1%). In four groups, the main indication for re-reintervention was recurrence of the pathology leading to the first reintervention: RiTKA for infection (59/355, 16.6%, P < .05), stiffness (18/174, 10.3%, P < .05), extensor mechanism failure (9/167, 5.4%, P < .05), and RiTKA for pain (4/137, 2.9%, P = .003). Global survival curve analysis found 87.9% survivorship without re-reintervention at one year and 83% at eight years. Contemporary RiTKA failures mainly occur in the first two postoperative years. Infection is the main cause of failure in RiTKA. Recurrence of the initial pathology occurs in four groups of RiTKA and is the main indication for re-reintervention in these groups; infection (16.6%), stiffness (10.3%), extensor mechanism failure (5.4%), and pain (2.9%).