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High early complication risk but low risk of re-revision beyond 5 years following revision knee arthroplasty in the elderly: An analysis of 2833 cases using real-world data from an international database

Lookup NU author(s): Professor David Deehan

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Abstract

© 2025 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.Purpose: With an increasing global elderly population, the number of revision total knee arthroplasties (rTKAs) in patients aged ≥80 years is rising. However, outcomes in this age group remain difficult to report and poorly understood. This study aimed to evaluate clinical outcomes, 90-day complication rates and long-term implant survivorship after rTKA in patients aged ≥80 years, and to compare results between revisions for aseptic loosening and prosthetic joint infection (PJI). Methods: Data were extracted from TriNetX, a global healthcare database covering 21 countries. Patients aged ≥80 years undergoing rTKA were included. Outcomes assessed included 90-day complications and mortality, crude re-revision rates at 2, 5 and 10 years, and implant and patient survivorship. Propensity score-matched analysis compared outcomes between aseptic loosening and PJI cohorts. Cox regression identified predictors of 90-day mortality and 2-year re-revision risk. Results: A total of 2833 patients were included. Ninety-day mortality was 2.7%. Acute kidney injury (AKI) was the most frequent complication (9.9%), particularly among PJI patients (18.2%). Crude re-revision rates were 9.3%, 10.4% and 10.5% at 2, 5 and 10 years, respectively, while implant survivorship was 87.7%, 83.6% and 81.8%. Ten-year patient survivorship was 38.8%. Patients with PJI had higher comorbidity burdens and postoperative complication rates. After matching, PJI patients showed increased risk of 90-day mortality (relative risk [RR] = 2.00, p = 0.051) and AKI (RR = 1.91, p < 0.001). Cox regression confirmed PJI as an independent predictor of 90-day mortality (hazard ratio [HR] = 2.51, p = 0.008) and 2-year re-revision (HR = 1.70, p = 0.001). Conclusions: Elderly patients undergoing rTKA for PJI exhibit greater comorbidity, higher complication rates and increased early mortality compared to those revised for aseptic loosening. Re-revision beyond 5 years is uncommon. In this population, outcomes such as mortality, mobility and quality of life may be more clinically meaningful than long-term implant survivorship. Level of Evidence: Level IV.

Publication metadata

Author(s): Tyas B, Williams J, Jameson S, Deehan D, Baker P

Publication type: Article

Publication status: Published

Journal: Knee Surgery, Sports Traumatology, Arthroscopy

Year: 2026

Volume: 34

Issue: 8

Pages: 2887-2896

Print publication date: 01/08/2026

Online publication date: 14/11/2025

Acceptance date: 25/10/2025

ISSN (print): 0942-2056

ISSN (electronic): 1433-7347

Publisher: John Wiley and Sons Inc

URL: https://doi.org/10.1002/ksa.70190

DOI: 10.1002/ksa.70190

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