Implant selection at elective aseptic revision of a primary total knee replacement: A scoping review and map of the evidence

Purpose The recent James Lind Alliance (JLA) Priority Setting Partnership (PSP) on ‘the problematic knee replacement’ highlighted implant selection at revision knee arthroplasty (rTKA) as a ‘Top 10’ research priority. The aims of this scoping review are to map the evidence for the implants used at first-time elective aseptic rTKA, to identify gaps in the evidence-base, and to provide recommendations for future research. Methods A scoping review was conducted in accordance with the Arksey and O’Malley framework and the Joanna Briggs Institute Manual for Evidence Synthesis, and reported according to the PRISMA extension for Scoping Reviews. A comprehensive search of MEDLINE, Embase, CINAHL, CDSR, CENTRAL, DARE, HTA, SCI, PROSPERO and KSR Evidence was conducted on 17 th August 2026, covering studies published between 2000 and 2026. Annual reports of 17 national joint replacement registries (NJRRs) were also sought. The review was registered on the Open Science Framework ( https://doi.org/10.17605/OSF.IO/SD49V ). Results Following deduplication, 7,096 research articles and 155 NJRR reports were identified. After applying eligibility criteria, 121 research articles and six NJRR reports were included. Twenty-two studies (18%) had cohorts clearly defined as exclusively comprising first-time elective aseptic rTKA procedures. The evidence consisted mostly of retrospective case series (45/121, 37%) and retrospective comparative studies (41/121, 34%). Most evidence was Level IV (48/121, 40%) or Level III (46/121, 38%) with no Level I evidence identified. Approximately half the studies were from the United States (58/102, 48%). Five studies (4%) reported mean or median follow up ≥10 years. A map of the evidence, tabulated by five key themes, is presented. Conclusions There is a lack of high-level comparative evidence to support implant selection at first-time elective aseptic rTKA. Future research should focus on more clinically homogeneous cohorts and compare outcomes associated with cemented versus hybrid/cementless stems, constraint levels, and metaphyseal fixation devices.