The Epidemiology of Revision Total Knee Arthroplasty in the United States

Overview

Journal Clin Orthop Relat Res

Publisher Wolters Kluwer

Specialty Orthopedics

Date 2009 Jun 26

PMID 19554385

Citations 411

Authors

Kevin J Bozic

Steven M Kurtz

Edmund Lau

Kevin Ong

Vanessa Chiu

Thomas P Vail

Harry E Rubash

Daniel J Berry

Affiliations

Soon will be listed here.

Abstract

Unlabelled: Understanding the cause of failure and type of revision total knee arthroplasty (TKA) procedures performed in the United States is essential in guiding research, implant design, and clinical decision making in TKA. We assessed the causes of failure and specific types of revision TKA procedures performed in the United States using newly implemented ICD-9-CM diagnosis and procedure codes related to revision TKA data from the Nationwide Inpatient Sample (NIS) database. Clinical, demographic, and economic data were reviewed and analyzed from 60,355 revision TKA procedures performed in the United States between October 1, 2005 and December 31, 2006. The most common causes of revision TKA were infection (25.2%) and implant loosening (16.1%), and the most common type of revision TKA procedure reported was all component revision (35.2%). Revision TKA procedures were most commonly performed in large, urban, nonteaching hospitals in Medicare patients ages 65 to 74. The average length of hospital stay (LOS) for all revision TKA procedures was 5.1 days, and the average total charges were $49,360. However, average LOS, average charges, and procedure frequencies varied considerably by census region, hospital type, and procedure performed.

Level Of Evidence: Level II, economic and decision analysis. See Guidelines for Authors for a complete description of levels of evidence.

Citing Articles

Natural course of postoperative C-reactive protein and erythrocyte sedimentation rate in unilateral and simultaneous bilateral total knee arthroplasty.

Incesoy M, Demirkiran C, Kaya H, Geckalan M, Tak A, Elmali N BMC Musculoskelet Disord. 2025; 26(1):260.

PMID: 40087715 DOI: 10.1186/s12891-025-08523-0.

Predicting periprosthetic joint infection in primary total knee arthroplasty: a machine learning model integrating preoperative and perioperative risk factors.

Chong Y, Lau C, Jiang T, Wen C, Zhang J, Cheung A BMC Musculoskelet Disord. 2025; 26(1):241.

PMID: 40069724 PMC: 11895328. DOI: 10.1186/s12891-025-08296-6.

Prognostic Value of C-Reactive Protein in Primary Total Hip Arthroplasty.

Mederake M, Hofmann U, Eleftherakis G Antibiotics (Basel). 2025; 14(2).

PMID: 40001448 PMC: 11851395. DOI: 10.3390/antibiotics14020205.

Anodized Ti6Al4V-ELI, electroplated with copper is bactericidal against Staphylococcus aureus and enhances macrophage phagocytosis.

Giraldo-Osorno P, Turner A, Barros S, Buscher R, Guttau S, Asaad F J Mater Sci Mater Med. 2025; 36(1):14.

PMID: 39853447 PMC: 11761993. DOI: 10.1007/s10856-024-06853-4.

The Etiology of Total Knee Arthroplasty Failure Influences on Improvement in Knee Function: A Follow-Up Study.

Weis S, Seifert L, Oltmanns M, Khury F, Bieger R, Faschingbauer M J Clin Med. 2025; 13(24.

PMID: 39768594 PMC: 11677656. DOI: 10.3390/jcm13247672.

References

Fehring T, Odum S, Griffin W, Mason J, Nadaud M . Early failures in total knee arthroplasty. Clin Orthop Relat Res. 2001; (392):315-8. DOI: 10.1097/00003086-200111000-00041. View

Keating E, Meding J, Faris P, Ritter M . Long-term followup of nonmodular total knee replacements. Clin Orthop Relat Res. 2002; (404):34-9. DOI: 10.1097/00003086-200211000-00007. View

Maloney W . An American implant registry: a clinical use trip wire. Orthopedics. 2002; 25(9):923-4. DOI: 10.3928/0147-7447-20020901-13. View

Vessely M, Whaley A, Harmsen W, Schleck C, Berry D . The Chitranjan Ranawat Award: Long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties. Clin Orthop Relat Res. 2006; 452:28-34. DOI: 10.1097/01.blo.0000229356.81749.11. View

Gonzalez M, Mekhail A . The failed total knee arthroplasty: evaluation and etiology. J Am Acad Orthop Surg. 2004; 12(6):436-46. DOI: 10.5435/00124635-200411000-00008. View

Peters Jr P, Engh G, Dwyer K, Vinh T . Osteolysis after total knee arthroplasty without cement. J Bone Joint Surg Am. 1992; 74(6):864-76. View

Segawa H, Tsukayama D, Kyle R, Becker D, Gustilo R . Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am. 1999; 81(10):1434-45. DOI: 10.2106/00004623-199910000-00008. View

Bengtson S, Knutson K . The infected knee arthroplasty. A 6-year follow-up of 357 cases. Acta Orthop Scand. 1991; 62(4):301-11. DOI: 10.3109/17453679108994458. View

Heck D, Melfi C, Mamlin L, Katz B, Arthur D, Dittus R . Revision rates after knee replacement in the United States. Med Care. 1998; 36(5):661-9. DOI: 10.1097/00005650-199805000-00006. View

10.

Kurtz S, Ong K, Lau E, Mowat F, Halpern M . Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4):780-5. DOI: 10.2106/JBJS.F.00222. View

11.

Maloney W . National Joint Replacement Registries: has the time come?. J Bone Joint Surg Am. 2001; 83(10):1582-5. DOI: 10.2106/00004623-200110000-00020. View

12.

Sharkey P, Hozack W, Rothman R, Shastri S, Jacoby S . Insall Award paper. Why are total knee arthroplasties failing today?. Clin Orthop Relat Res. 2002; (404):7-13. DOI: 10.1097/00003086-200211000-00003. View

13.

Kramhoft M, Bodtker S, Carlsen A . Outcome of infected total knee arthroplasty. J Arthroplasty. 1994; 9(6):617-21. DOI: 10.1016/0883-5403(94)90115-5. View

14.

Mahomed N, Barrett J, Katz J, Baron J, Wright J, Losina E . Epidemiology of total knee replacement in the United States Medicare population. J Bone Joint Surg Am. 2005; 87(6):1222-8. DOI: 10.2106/JBJS.D.02546. View

15.

Emmerson K, Moran C, Pinder I . Survivorship analysis of the Kinematic Stabilizer total knee replacement: a 10- to 14-year follow-up. J Bone Joint Surg Br. 1996; 78(3):441-5. View

16.

Huang C, Liau J, Cheng C . The incidence of revision of the metal component of total knee arthroplasties in different tibial-insert designs. Knee. 2002; 9(4):331-4. DOI: 10.1016/s0968-0160(02)00054-6. View

17.

Bourne R, Maloney W, Wright J . An AOA critical issue. The outcome of the outcomes movement. J Bone Joint Surg Am. 2004; 86(3):633-40. DOI: 10.2106/00004623-200403000-00026. View

18.

Quintana J, Arostegui I, Escobar A, Azkarate J, Goenaga J, Lafuente I . Prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in an older population. Arch Intern Med. 2008; 168(14):1576-84. DOI: 10.1001/archinte.168.14.1576. View

19.

Wilde A, Ruth J . Two-stage reimplantation in infected total knee arthroplasty. Clin Orthop Relat Res. 1988; (236):23-35. View

20.

Saleh K, Santos E, Ghomrawi H, Parvizi J, Mulhall K . Socioeconomic issues and demographics of total knee arthroplasty revision. Clin Orthop Relat Res. 2006; 446:15-21. DOI: 10.1097/01.blo.0000214416.91216.77. View