Principles and Techniques of Total Knee Revision Surgery

Abstract

Failed total knee arthroplasty presents numerous diagnostic and management challenges for the arthroplasty surgeon. Successful revision arthroplasty requires a thorough patient history, physical examination, and imaging evaluation, with a clear indication for revision identified prior to the procedure. Once a failure mode is identified, preoperative planning is essential to the success of revision arthroplasty. The revision procedure follows a stepwise algorithmic approach based on the preoperative plan, which includes wide surgical exposure for optimal joint visualization. When contemplating options for constraint in revision total knee arthroplasty, a variety of issues must be considered. The surgeon must assess the flexion and extension gaps, position of the joint line, ligament and extensor mechanism integrity, and the degree of bone loss. Expedient and successful removal of implants during revision total knee arthroplasty hinges on optimal exposure of the implants and interfaces. Careful removal of components, limiting of iatrogenic bone loss, and preservation of vital soft tissues are paramount. In addition, the surgeon must be prepared to encounter more severe ligamentous compromise and bone loss than was anticipated preoperatively. Multiple treatment options exist for the management of bone loss and ligamentous compromise, and implants and allograft must be readily available to accommodate these situations, should they arise. Postoperative rehabilitation must be patient-specific and be guided by implant fixation, the need to protect bone graft, and ligament and extensor mechanism integrity.

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