Impact of patient and prosthesis characteristics on common reasons for total knee replacement revision: a registry study of 36,626 revision cases from Australia, Sweden, and USA

BACKGROUND AND PURPOSE: Total knee replacement (TKR) studies usually analyze all-cause revision when considering relationships with patient and prosthesis factors. We studied how these factors impact different revision diagnoses. PATIENTS AND METHODS: We used data from 2003 to 2019 of TKR for osteoarthritis from the arthroplasty registries of Sweden, Australia, and Kaiser Permanente, USA to study patient and prosthesis characteristics for specific revision diagnoses. There were 1,072,924 primary TKR included and 36,626 were revised. Factors studied included age, sex, prosthesis constraint, fixation method, bearing mobility, polyethylene type, and patellar component use. Revision diagnoses were arthrofibrosis, fracture, infection, instability, loosening, pain, patellar reasons, and wear. Odds ratios (ORs) for revision were estimated and summary effects were calculated using a meta-analytic approach. RESULTS: We found between-registry consistency in 15 factor/reason analyses. Risk factors for revision for arthrofibrosis were age < 65 years (OR 2.0; 95% CI 1.4–2.7) and mobile bearing designs (MB) (OR 1.7; CI 1.1–2.5), for fracture were female sex (OR 3.2; CI 2.2–4.8), age ≥ 65 years (OR 2.8; CI 1.9–4) and posterior stabilized prostheses (PS) (OR 2.1; CI 1.3–3.5), for infection were male sex (OR 1.9; CI 1.7–2.0) and PS (OR 1.5; CI 1.2–1.8), for instability were age < 65 years (OR 1.5; CI 1.3–1.8) and MB (OR 1.5; CI 1.1–2.2), for loosening were PS (OR 1.5; CI 1.4–1.6), MB (OR 2.2; CI 1.6–3.0) and use of ultra-high molecular weight polyethylene (OR 2.3; CI 1.8–2.9), for patellar reasons were not resurfacing the patella (OR 13.6; CI 2.1–87.2) and MB (OR 2.0; CI 1.2–3.3) and for wear was cementless fixation (OR 4.9; CI 4.3–5.5). INTERPRETATION: Patients could be counselled regarding specific age and sex risks. Use of minimally stabilized, fixed bearing, cemented prostheses, and patellar components is encouraged to minimize revision risk.