The National Joint Registry (NJR) for England & Wales provides a useful reference for hospitals to assess and compare their current practice with national figures. We aimed to identify patient and surgical factors at time of primary total knee arthroplasty (TKA) responsible for the revision.

A retrospective case note review was performed of all revision TKAs performed at Musgrove Park Hospital 2005–2010. Exclusion criteria included primary TKA performed elsewhere.

38 TKAs and 13 unicompartmental knee arthroplasties (UKAs) were revised. Mean time to revision was 1.8 years and 2.1 years respectively. Reason for revision was pain or disease progression in 54% revised UKAs and infection in 53% revised TKAs. 35% infected cases were therapeutically anticoagulated, 75% ASA 3 and 50% had a BMI >30. No problems were identified with surgeon grade or level of supervision. 5 cases of revision were of a trial primary prosthesis.

There were large numbers of high risk patients (increased BMI, ASA grade or on anticoagulants), which may contribute to increased infection rates and subsequent revision. We suggest avoiding trial prostheses and recommend delaying anticoagulation reintroduction until the wound is fully healed. This information may be useful for aiding with patient selection and consent.