REGISTRY REVIEW: Revision Total Knee Arthroplasty in the US
Why do total knee arthroplasties (TKA) fail in the US?
According to data from the American Joint Replacement Registry (AJRR) – which includes the details on more than 75,000 revision TKAs performed in the US between 2012 and 2019 – the top 3 reasons for revision surgery are infection/inflammatory response, mechanical loosening, and other mechanical complications (Figure 1).
Figure 1. Diagnoses Leading to Revision TKA
Based on data from the 2020 Annual Report from the American Joint Replacement Registry
The AJRR data show that the percentage of revisions resulting from infection or inflammatory response steadily increased, growing from 16.1% of revision causes in 2012 to 23.1% in 2019. In addition, infection or inflammatory response was the by far the most common reason for early revisions, defined as occurring within the first 3 months after the index procedure, at 64.2%.
Overall, the AJRR data are consistent with the findings of Delanois et al,  Bozic et al,  and Schwartz et al,  all of whom used the National Inpatient Sample to identity the causes of revision TKA. Schwartz et al further projected that the incidence of revision TKA will increase between 78% and 182% by 2030, with the greatest increases seen in the 55-64 and 65-74 age groups. 
Besides information on diagnoses leading to revision TKA, data in AJRR’s 2020 Annual Report show that between 2012 and 2019:
Use of antioxidant polyethylene inserts has increased significantly, as it did with primary TKA. Highly cross-linked polyethylene inserts and conventional polyethylene inserts were used about equally in revision procedures, at 44.7% and 41.07%, respectively, in 2019. But use of antioxidant polythene inserts has been coming on strong, increasing from just 1.27% of revision TKAs in 2012 to 14.17% in 2019.
Triathlon has become the most commonly used tibial/femoral system for revision TKA. Sigma/MBT was the predominant tibal/femoral system in 2012, but by 2013, it was losing ground to Triathlon. By 2018, Triathlon had pulled out in front significantly, with use of Sigma/MBT dropping substantially. Use of the Attune and Legion revisions systems significantly eclipsed Sigma/MBT by 2019 to become the number 2 and number 3 systems, respectively.
Most patients were discharged home after revision TKA, as with primary TKA. However, the percentage who were discharged home with or without home healthcare was lower for a revision procedure than for a primary procedure: 78.5% versus 87.2%, respectively, in 2019. Another 17.4% of patients were discharged to a skilled nursing facility for additional care, with the remainder of patients discharged to a combination of inpatient care facilities, inpatient rehabilitation facilities, and other types of facilities.
The 2020 Annual Report from AJRR can be found here.
- Delanois RE, Mistry JB, Gwam CU, Mohamed NS, Choksi US, Mont MA. Current epidemiology of revision total knee arthroplasty in the United States. J Arthroplasty. 2017 Sep;32(9):2663-2668. doi: 10.1016/j.arth.2017.03.066. Epub 2017 Apr 6.
- Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010 Jan;468(1):45-51. doi: 10.1007/s11999-009-0945-0. Epub 2009 Jun 25.
- Schwartz AM, Farley KX, Guild GN, Bradbury TL Jr. Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2030. J Arthroplasty. 2020 Jun;35(6S):S79-S85. doi: 10.1016/j.arth.2020.02.030. Epub 2020 Feb 19.