Isolated versus Full-Component Revision Total Knee Arthroplasty for Aseptic Loosening: Systematic Review and Meta-Analysis.
BACKGROUND Aseptic loosening after total knee arthroplasty (TKA) is a challenging complication. Outcomes regarding an isolated versus full component revision TKA (rTKA) are not well summarized in the literature. To address this, we conducted a systematic review of the literature regarding this topic along with a meta-analysis to clarify inconsistent conclusions in the literature. METHODS We used Embase.com, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov to search from their inception to September 17, 2025. A bias quality assessment was conducted for each study included. There were 11 studies that were included in the final analysis to assess for and compare complications, implant failures, and functional results between isolated versus full component rTKA. Across 11 studies (median cases: 164; mean age: 66 years; 65.8% women) RESULTS: Isolated and full component rTKA demonstrated comparable rates of re-revision for all indications (odds ratio (OR): 1.36, 95% confidence interval (CI) 0.96 to 1.95, P = 0.094, I2 = 23.5%), including aseptic loosening (OR: 0.76, 95% CI 0.40 to 1.47, P = 0.42, I2 = 7.0%) and periprosthetic joint infection (OR: 1.23, 95% CI 0.52 to 2.92, P = 0.64, I2 = 7.5%). The isolated component rTKA showed significantly reduced operative time (Standardized Mean Difference = 2.85, 95% CI 1.47 to 4.23, P < 0.001, I2 = 98.8%), and two studies reported lower intraoperative blood loss, while postoperative range of motion was similar between approaches without consistent differences. CONCLUSIONS In this systematic review and meta-analysis, isolated component revision demonstrated outcomes comparable to full component revision. These findings support the idea that when components are well-fixed and compatible, isolated component revision may serve as a less morbid option for rTKA. Additional prospective and longer-term studies are required to corroborate these findings. LEVEL OF EVIDENCE I.