Increased Aseptic Tibial Failures in Patients With a BMI ≥ 35 and Well-Aligned Total Knee Arthroplasties

The purpose of this study was to calculate the risk of revision secondary to aseptic tibial loosening correlated with increased BMI in 5088 primary TKAs. The mean age was 69 years, with a mean follow-up of 7 years. Fifty-two (1.0%) revision TKAs were performed due to aseptic tibial loosening, with the 15-year risk being 2.7%. Patients with a BMI ≥ 35 kg/m2 were significantly more likely to undergo revision due to aseptic tibial failure (HR = 1.9; P < 0.05). Coronal alignment was equivalent between those who did and did not experience tibial loosening. Given that the risk of revision TKA due to aseptic tibial component failure is 2-fold greater in those with a BMI of ≥ 35 kg/m2, consideration should be given to additional fixation. Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.