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What can cause a total knee replacement to fail?

The most common cause of total knee replacement failure is loosening or de-bonding of the implant from the bone. This is called aseptic loosening. Other uncommon reasons for total knee replacement to fail include:

  • infection
  • instability
  • possible allergy to the implant or cement
  • trauma (i.e., a fall and break around the replacement)
  • unexplained pain (experienced by up to 10 percent of people who have total knee replacement)
Dr. William A. Leone, MD
Orthopedic Surgeon

Approximately 20 percent of people who have total knee replacement (TKR) surgery are not happy with their results. Occasionally, even when a TKR “looks good on paper,” more surgery is required to correct and improve the existing outcome. If TKR revision truly is necessary, then the specific reason for the failure must be understood fully before it can be corrected. Often, there is more than one mechanical problem.

Sometimes no specific correctible cause or causes are diagnosed. For example, the leg may be satisfactorily aligned, the incision might appear healed and unremarkable, and the range of motion may or may not be satisfactory. Clinically, the knee might not appear infected. Furthermore, x-rays may also appear satisfactory. Often, the person will have had many months of extensive physical therapy following TKR. Such a person falls into the “looks good but feels bad” syndrome. Unfortunately, it is not uncommon.

Occasionally, doctors find that the tissues that envelop the total knee and define the joint space will have an abnormal tissue reaction secondary to metal sensitivity.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.