Predictors of undergoing revision within five years of total knee arthroplasty: a population-based study

Background — The objective of this study was to identify the rate and risk factors for revision total knee arthroplasty (TKA) within the first five years postoperative. Our secondary objective was to identify the rate of additional surgical procedures and death.

Methods — We conducted a retrospective cohort study among patients in Ontario, Canada who underwent an elective, primary TKA for osteoarthritis between April 1, 2007 and March 31, 2014 for a diagnosis of osteoarthritis. We excluded patients under 40 years of age and those who had undergone a TKA within the previous 15 years. Our final study cohort included 94,193 patients. We reported the proportion of the study cohort who experienced revision surgery within 2 and 5 years of the primary TKA; secondary surgery within 5 years, and death within 5 years of primary TKA. We conducted Cochran-Armitage tests for trends to assess changes in the proportion of patients who experienced each of the study outcomes over the study period. We performed multivariable logistic regressions to evaluate predictors of a revision TKA.

Results — There were 3,112 (3.3%) patients who had a revision within five years of their primary TKA, and 1,866 (2.0%) who had a revision within two years and 3,316 (3.5%) patients had a secondary surgery within 5 years (i.e., 0.6% patellar resurfacing; 1.6% manipulation; 1.3% synovectomy; 0.5% washout; 0.9% debridement). Lower age, men, lower income, higher comorbidity score, depression, previous arthroscopy, lower surgeon volume, and general anesthesia were all significant positive predictors of revision.

Conclusion — In our study cohort, 2.0% of patients had a revision TKA within two years of their primary TKA, and 3.3% within five years. Preoperative identification of risk factors may reduce the future prevalence of revision TKAs.