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Specific modes of failure require specific surgical solutions. Causes of failure are often presented as a list or catalogue, without a system or process for making a decision. In addition, strict definitions and consensus on modes of failure are lacking in published series and registry data. How we approach the problem TKR is an essential but neglected aspect of understanding knee replacement surgery. It must be carried out systematically, comprehensively and efficiently. Eight modes of failure are described: 1) sepsis; 2) extensor discontinuity; 3) stiffness; 4)\u00a0tibial- femoral instability; 5) patellar tracking; 6) aseptic loosening and osteolysis; 7) periprosthetic fracture and 8) component breakage. A ninth \u2018category\u2019, unexplained pain is an indication for further investigation but not surgery.<\/jats:p><jats:p>Cite this article: Bone Joint J 2014;96-B(11 Suppl A):105\u201311.<\/jats:p>","DOI":"10.1302\/0301-620x.96b11.34531","type":"journal-article","created":{"date-parts":[[2014,11,7]],"date-time":"2014-11-07T15:04:23Z","timestamp":1415372663000},"page":"105-111","update-policy":"https:\/\/doi.org\/10.1302\/crossmark-policy","source":"Crossref","is-referenced-by-count":42,"title":["The problem total knee replacement"],"prefix":"10.1302","volume":"96-B","author":[{"given":"K. G.","family":"Vince","sequence":"first","affiliation":[{"name":"Northland District Health Board, Department of Orthopaedic Surgery, Whangarei, New Zealand."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"r1","unstructured":"Groopman JEHow doctors think. 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