Etiology of total knee arthroplasty failure and functional outcome of revision knee arthroplasty

doi:10.5312/wjo.v16.i11.111857

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Nov 18, 2025 (publication date) through Nov 22, 2025

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Orthop. Nov 18, 2025; 16(11): 111857
Published online Nov 18, 2025. doi: 10.5312/wjo.v16.i11.111857

Etiology of total knee arthroplasty failure and functional outcome of revision knee arthroplasty

Syed Muhammad Tayyab Hassan, Shahid Hussain, Shafqat Wasim, Tauseef Raza, Naveed Khan, Syed Abdur Rub Abidi, Kashif Anwar, Hamdoon Suharwardy Asim, Elham Shenawa

Syed Muhammad Tayyab Hassan, Department of Orthopedics, Allied Hospital Faisalabad, Faisalabad 38000, Punjab, Pakistan

Shahid Hussain, Department of Orthopedics, General Hospital Timergara, Timargara 18300, Khyber Pakhtunkhwa, Pakistan

Shafqat Wasim, Department of Orthopedics, Allama Iqbal Medical College/Jinnah Hospital Lahore, Lahore 54550, Punjab, Pakistan

Tauseef Raza, Department of Orthopedics, Khyber Medical University Institute of Medical Sciences Kohat, Kohat 26000, Khyber Pakhtunkhwa, Pakistan

Naveed Khan, Department of Orthopedics, Medicare Cardiac and General Hospital, Karachi 74000, Sindh, Pakistan

Syed Abdur Rub Abidi, Department of Orthopedics, Jinnah Medical and Dental College, Karachi 74800, Sindh, Pakistan

Kashif Anwar, Department of Orthopedics, Jinnah Postgraduate Medical Center, Karachi 75510, Sindh, Pakistan

Hamdoon Suharwardy Asim, Department of Orthopaedics, Dartford and Gravesham NHS Trust, DA2 8DA, England, United Kingdom

Elham Shenawa, Department of Surgery, Balkh University, Balkh 1702, Afghanistan

Co-first authors: Syed Muhammad Tayyab Hassan and Shahid Hussain.

Author contributions: Hassan SMT and Hussain S contributed equally to this manuscript and are co-first authors. Wasim S, Raza T, Khan N, Abidi SAR, and Anwar K led formal analysis; Hassan SMT, Hussain S, and Wasim S led the conceptualization and methodology; Asim HS and Shenawa E contributed to critical review and final editing of the manuscript. All authors contributed to writing and reviewing the manuscript. All authors thoroughly reviewed and approved the final version of the manuscript.

Institutional review board statement: Ethical approval was obtained from the Ethical Review Board of the Jinnah Hospital, Lahore, Pakistan.

Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: All data collected during the study are available from the corresponding author by request at eshenawa@gmail.com.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Elham Shenawa, MD, Department of Surgery, Balkh University, Chuk Sancharki, Mazar-i-Sharif, Balkh 1702, Afghanistan. eshenawa@gmail.com

Received: July 11, 2025
Revised: July 19, 2025
Accepted: September 30, 2025
Published online: November 18, 2025
Processing time: 126 Days and 17.4 Hours

Abstract

BACKGROUND

Total knee arthroplasty (TKA) is a widely used treatment for advanced knee osteoarthritis; however, the incidence of failures requiring revision surgery is increasing. Identifying the causes of TKA failure and assessing the outcomes of revision procedures are essential for improving patient care. We hypothesized that infection and aseptic loosening are the primary causes of TKA failure and that revision TKA (rTKA) significantly enhances functional outcomes.

AIM

To examine the primary causes of TKA failure and evaluate the functional outcomes following rTKA.

METHODS

This descriptive study was conducted at the Department of Orthopedic Surgery, Civil Hospital, Bahawalpur, from April to September 2024. A total of 118 patients undergoing rTKA for failed primary TKA were included. Data on demographics, causes of failure, and surgical details were collected. Functional outcomes were evaluated using the Knee Society Score and Visual Analog Scale before and six months after surgery. Statistical analysis was performed using SPSS version 25.0, with statistical significance set at P < 0.05.

RESULTS

The leading causes of TKA failure were infection (45.8%), aseptic loosening (44.1%), and periprosthetic fractures (10.2%). The rTKA significantly improved knee function, with the mean Knee Society Score increasing from 39.43 ± 6.18 to 78.91 ± 6.17 (P < 0.001). Pain levels decreased substantially, with the mean Visual Analog Scale scores reducing from 7.99 ± 1.37 to 1.42 ± 1.17 (P < 0.001). No significant differences in outcomes were observed between single-stage and two-stage revision procedures.

CONCLUSION

Infection and aseptic loosening are the predominant causes of TKA failure. The rTKA effectively enhances knee function and alleviates pain, offering significant benefits to patients.

Keywords: Total knee arthroplasty; Revision surgery; Knee Society Score; Visual Analog Scale; Functional outcomes; Infection; Aseptic loosening

Core Tip: Total knee arthroplasty failures, primarily due to infection and aseptic loosening, present significant clinical challenges. This study demonstrates that revision total knee arthroplasty significantly enhances knee function and pain relief, as shown by substantial improvements in Knee Society Score and Visual Analog Scale scores. These findings underscore the effectiveness of revision procedures in addressing complications and optimizing patient outcomes, providing valuable insights for clinicians to improve surgical strategies and postoperative care.