How can early revision of total knee arthroplasty be prevented?

To our work; 163 patients, 100 late and 63 early, were included. The reasons for revision of the patients were examined in 7 categories, in order of frequency: aseptic loosening, infection, periprosthetic fracture, malposition, instability, PE wear, and pain. When considering all patients, the reasons for revision of total knee arthroplasty (TKA) were aseptic loosening (35.5%), infection (30.6%), periprosthetic fracture (11.6%), malposition (9.9%), dislocation (5.5%), PE wear (4.2%), and persistent pain (2.4%). Aseptic loosening was the most common reason for TKA revision. Aseptic loosening of the prosthesis was generally the most common etiology of failure, constituting 35.5% of all revision procedures. Aseptic loosening of the prosthesis was more common in the late revision group (p <0.001) and comprised 46% of patients undergoing revision two years after primary arthroplasty. In contrast, aseptic loosening accounted for 19% of early revision cases. In the early revision group, the most common mechanism of failure was infection (p <0.048), responsible for 39.6% of revisions performed within two years of the primary procedure. Infection also constituted 25% of revisions in the late failure group and 30.6% of all revision TKA procedures in our study. Malposition was a significant reason for early revision in our study (p <0.02). Sixteen patients (9.9%) underwent revision due to malposition, with 12 of them in the early revision group and 4 in the late revision group. Seven patients (4.2% of all patients) in our study required revision due to PE wear. PE wear did not cause early revisions in our study; all seven patients were in the late revision group (p <0.032). Infection, malposition, and instability are preventable causes of early revision of primary TKA. Considering this situation, we can conclude that 66%, or approximately 2/3, of the patients in our study who underwent early revision underwent revision surgery for preventable reasons. Surgical attention and care can help us avoid these complications that are difficult for the patient and the doctor to manage in primary TKA.