There is limited information in English literature regarding the cause of revision total knee arthroplasty (TKA) in emerging economies. The purpose of this study is to report a detailed analysis of the TKA failure mechanisms from a referral hospital in India and to determine whether the failure mechanisms of primary TKA are different from that of the western world. A total of 53 revision TKAs performed at our institution over the past 5 years were identified. The revision TKA group was divided into subgroups according to the cause of failure, including infection, aseptic loosening, periprosthetic fracture, instability, extensor mechanism failure, and other causes. All revision TKA patients were subdivided into early (less than 2 years from primary) and late (more than 2 years from primary) failure groups depending upon the time interval between primary TKA and revision procedure. The overall common failure mechanisms were infection (73.58%), aseptic loosening (13.2%), and periprosthetic fracture (5.6%). Infection was the most common failure mechanism for early revision (< 2 years from primary) and aseptic loosening was the most common reason for late revision. Our study shows a pattern similar to the earliest trends of revision TKA in western literature reporting infection as the major cause for revision. The level of evidence for the study is Level 3.