Repeat Revision Total Knee Arthroplasty Has Significantly Lower Survivorship Compared to First-Time Revisions.

Background: Revision total knee arthroplasty (rTKA) is an increasingly common challenge for arthroplasty surgeons. Compared to first-time rTKA, re-rTKA presents additional challenges, including further compromised soft tissues and bone loss, abundant scar tissue, stemmed revision implants, and metaphyseal fixation. The goal of this study was to compare the survivorship and clinical outcomes of aseptic first-time rTKAs and re-rTKAs.

Methods: A retrospective review of aseptic rTKAs from a single institution from 2016 to 2022 identified 850 first-time rTKAs and 178 re-rTKAs. The mean age was 67 years, 58% were women, and the mean body mass index was 31. The mean operative time was longer for re-rTKAs (173 versus 160 minutes, P = 0.02), as was the hospital length of stay for the re-rTKA cohort (3.7 versus 3.2 days, P = 0.0007). Failure was defined as all-cause revision or revision for periprosthetic joint infection (PJI).

Results: At 3.5 years, re-rTKAs had significantly lower survivorship free from all-cause revision than the first-time rTKA cohort (75 versus 91%, P < 0.0001). At 1.5 years, re-rTKAs had significantly lower survivorship free from revision for PJI than the first-time rTKA cohort (93 versus 98%, P = 0.003). Overall, the re-rTKA cohort had more all-cause failures (33 [19%] versus 55 [6%]; P < 0.0001) and more PJI failures (13 [7%] versus 17 [2%]; P = 0.0001). At the final follow up, the re-rTKA cohort had a significantly lower Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (62 versus 69, P = 0.01).

Conclusions: Compared to first-time rTKA, re-rTKA has significantly decreased survivorship free from all-cause revision at 3.5 years (58 versus 43%) and revision for PJI at 2 years (91 versus 98%). Optimization of care for rTKA patients at centers of excellence may improve the outcomes and care of these complex patients.