title: Causes, risk factors, and trends in failures after TKA in Korea over the past 5 years: a multicenter study.
abstract: BACKGROUND
  Failure after total knee arthroplasty (TKA) may be related to emerging technologies, surgical techniques, and changing patient demographics. Over the past decade, TKA use in Korea has increased substantially, and demographic trends have diverged from those of Western countries, but failure mechanisms in Korea have not been well studied.
  
  
  OBJECTIVE
  We determined the causes of failure after TKA, the risk factors for failure, and the trends in revision TKAs in Korea over the last 5 years.
  
  
  METHODS
  We retrospectively reviewed 634 revision TKAs and 20,234 primary TKAs performed at 19 institutes affiliated with the Kleos Korea Research Group from 2008 to 2012. We recorded the causes of failure after TKA using 11 complications from the standardized complication list of The Knee Society, patient demographics, information on index and revision of TKAs, and indications for index TKA. The influences of patient demographics and indications for index TKA on the risk of TKA failure were evaluated using multivariate regression analysis. The trends in revision procedures and demographic features of the patients undergoing revision TKA over the last 5 years were assessed.
  
  
  RESULTS
  The most common cumulative cause of TKA failure was infection (38%) followed by loosening (33%), wear (13%), instability (7%), and stiffness (3%). However, the incidence of infections has declined over the past 5 years, whereas that of loosening has increased and exceeds that of infection in the more recent 3 years. Young age (odds ratio [OR] per 10 years of age increase, 0.41; 95% confidence interval [CI], 0.37-0.49) and male sex (OR, 1.88; 95% CI, 1.42-2.49) were associated with an increased risk of failure. The percentage of revision TKAs in all primary and revision TKAs remained at approximately 3%, but the annual numbers of revision TKAs in the more recent 3 years increased from that of 2008 by more than 23%.
  
  
  CONCLUSIONS
  Despite a recent remarkable increase in TKA use and differences in demographic features, the causes and risk factors for failures in Korea were similar to those of Western countries. Infection was the most common cause of failure, but loosening has emerged as the most common cause in more recent years, which would prompt us to scrutinize the cause and solution to reduce it.
authors: Department of Orthopaedic Surgery, Uijeongbu St Mary's Hospital, Gyeonggi-do, Korea.
authors: In Jun
authors: IJ
authors: Koh
authors: Woo-Shin
authors: WS
authors: Cho
authors: Nam Yong
authors: NY
authors: Choi
authors: Tae Kyun
authors: TK
authors: Kim
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000639:trends; D005260:Female; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000209:etiology* / Q000639:trends; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000209:etiology; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
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