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Revision Total Knee Arthroplasty: Exposure and Component Removal

February 19, 2016

Contributors: Mark P Figgie, MD; Lucian C Warth, MD; Douglas E Padgett, MD; Alberto Carli, MD; Alberto Carli, MD

In the past decade, the incidence of revision total knee arthroplasty (TKA) has increased steadily in the United States. A 2010 study of the Nationwide Implant Sample Database reported that the most common type of revision TKA (35.2%) involved removal of the femoral and tibial components. For most orthopaedic surgeons, performing such a procedure is no small task because it requires rigorous preoperative planning and thorough knowledge of knee anatomy. Given the increasing incidence of revision TKA, we created this video to demonstrate the key steps for exposure and removal of well-fixed components in a knee in which surgery has been previously performed. The video begins begin by reviewing the vascular supply to the anterior knee and how to select a surgical incision. The video then discusses our approach to systematically expose the knee in a step-wise fashion, which includes clearing the medial and lateral gutters, performing anteromedial tibial release, and mobilizing the extensor mechanism. The video also describes advanced techniques to mobilize the patella, which include inside-out lateral release and the quadriceps snip. Removal of various polyethylene inserts is shown to demonstrate the variability of insert locking mechanisms. The second portion of the video demonstrates removal of well-fixed femoral and tibial components. The video compares the various steps required to remove cemented and noncemented components. The final portion of the video discusses tips and tricks for removal of a fully cemented, stemmed tibial component. Via a first-person intraoperative perspective, the video demonstrates how to carefully manipulate high-speed burrs and trephines to remove implants while minimizing bone loss. We believe that good exposure is the cornerstone to successful revision TKA and hope that aspiring arthroplasty surgeons find this video helpful in planning their next component revision.