BACKGROUND: The incidence of primary total knee arthroplasty (pTKA) is projected to rise, leading to an increase in revision TKAs (rTKA). As rTKA imposes a considerable burden, this study aimed to: 1) analyze indications for rTKA over the past decade
2) differentiate early and late failures, as well as recent and past revisions
and 3) compare demographics and used constraints across major revision indications. METHODS: A retrospective analysis was conducted on 483 rTKA patients at a tertiary center between 2013 and 2023. Revision causes were categorized based on patient records and predefined criteria. Subgroup analyses for primary revisions differentiated early and late failures (with two years as the cutoff) and compared recent to past revisions (before and after June 2018). Demographics and the prosthetic constraint used during revision were compared across the most common primary revision causes: periprosthetic joint infection (PJI), instability, malalignment, and aseptic loosening. RESULTS: Among 368 primary revisions, PJI was the most common cause (24.3%), followed by malalignment (21%) and instability (19.1%). Aseptic loosening was the leading indication for re-revision (34.8%), followed by PJI (27.8%) and instability (13.9%). Early revisions had PJI (29.2%) as the leading cause, while aseptic loosening (22.2%) predominated in late revisions. No significant differences in major indications were found between recent and past revisions. A PJI was associated with men (P <
0.001), an American Society of Anesthesiologists (ASA) classification of 3 (P = 0.005), and the use of rotating hinged implants (P <
0.001). CONCLUSION: Periprosthetic joint infection remained the leading indication for primary revisions, while aseptic loosening predominated in re-revisions. A PJI was the leading cause in early revisions, while aseptic loosening prevailed in late revisions. A PJI was notably associated with men and ASA 3 as risk factors, with rotating hinged implants more commonly used for revision.