Does the indication for revision associate with the outcomes of revision total knee arthroplasty? A retrospective analysis with a minimum ten-year follow-up

Abstract Background The long-term outcome of revision total knee arthroplasty (rTKA) remains variable. We aimed to determine whether the indication for revision affects rTKA outcomes and assess the risk factors for rTKA failure. Methods We reviewed all patients who underwent their first rTKA at our institution between January 2003 and December 2011. Patients were grouped based on the indication for revision. All patients with septic indications underwent staged exchange arthroplasty for periprosthetic joint infection (PJI). Demographic and perioperative variables were compared to analyze the survivorships and the risk factors for treatment failure and implant failure between septic and aseptic indications. Results Two-hundred-and-thirty patients (septic indication, 116 patients; aseptic indication, 114 patients) were included. The minimum follow-up duration was 10.3 years (mean: 12.3 years; range: 10.3–19.1 years). The overall treatment success rate of rTKA was 88.3% (203/230). The septic group had a significantly higher failure rate (18.10% vs. 5.26%, p < 0.05) and required earlier re-operation after index revision (14.6 vs. 23.0 months, p < 0.05) than the aseptic group. The identified risk factor in septic group for treatment failure and implant failure is “higher CRP level (> 100 mg/dl) during the first PJI episode before index revision” and “debridement, antibiotics, and implant retention procedure (DAIR) after index rTKA”, respectively. Severe osteoporosis with a history of periprosthetic fracture is the only independent risk factor for implant failure in aseptic group. Conclusions One-third of patients with septic indication for rTKA underwent re-operation, mostly for PJI. Identified risk factors for different indications could associate with unfavorable survivorships.