Abstract
The number of patients requiring revision of total knee arthroplasty (RTKA) is increasing, despite improvements in technique and implant design. RTKA is a complex procedure that requires a preoperative evaluation so that the proper equipment and prostheses are available in the operating room. Revision knee surgery is a two-step process involving implant removal and joint reconstruction. It is important to select the optimal exposure, to avoid avulsion of the patellar tendon insertion. Component removal is a critical step in successful revision arthroplasty; the goal is preservation of bone stock and prevention of iatrogenic fractures. Adequate joint reconstruction will be achieved by balancing ligaments and flexion/extension gaps, managing bone loss, achieving adequate fixation, and choosing the appropriate revision implant/constraint.
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References
Abdel MP, Della Valle CJ. The surgical approach for revision total knee arthroplasty. Bone Joint J. 2016;98-B(1 Suppl A):113–5.
Santore RF, Kaufman D, Robbins AJ, Dabezies EJ Jr. Tissue expansion prior to revision total knee arthroplasty. J Arthroplasty. 1997;12:475–8.
Meek RM, Greidanus NV, McGraw RW. The extensile rectus snip exposure in revision of total knee arthroplasty. J Bone Joint Surg. 2003;85:1120–31.
Bellemans J. Implant removal in revision total knee arthroplasty. In: Scuderi GR, editor. Techniques in revision hip and knee arthroplasty. Philadelphia, PA: Elsevier; 2015. p. 64–9.
Nett MP, Scuderi GR. Revision of aseptic failed total knee arthroplasty. Scott WN(Ed). In: Insall and Scott surgery of the knee. New York, NY: Elsevier; 2018. p. 1897–915.
Porteous AJ, Hassaballa MA, Newman JH. Does the joint line matter in revision total knee replacement? J Bone Joint Surg Br. 2008;90:879–84.
Lei PF, Hu RY, Hu YH. Bone defects in revision total knee arthroplasty and management. Orthop Surg. 2019;11:15–24.
Zanirato A, Formica M, Cavagnaro L, Divano S, Burastero G, Felli L. Metaphyseal cones and sleeves in revision total knee arthroplasty: two sides of the same coin? Complications, clinical and radiological results-a systematic review of the literature. Musculoskelet Surg. 2019; https://doi.org/10.1007/s12306-019-00598-y.
Fedorka CJ, Chen AF, Pagnotto MR, Crossett LS, Klatt BA. Revision total knee arthroplasty with porous-coated metaphyseal sleeves provides radiographic ingrowth and stable fixation. Knee Surg Sports Traumatol Arthrosc. 2018;26:1500–5.
Divano S, Cavagnaro L, Zanirato A, Basso M, Felli L, Formica M. Porous metal cones: gold standard for massive bone loss in complex revision knee arthroplasty? A systematic review of current literature. Arch Orthop Trauma Surg. 2018;138:851–63.
Morgan-Jones R, Oussedik SI, Graichen H, Haddad FS. Zonal fixation in revision total knee arthroplasty. Bone Joint J. 2015;97-B:147–9.
Rodríguez-Merchán EC, Gómez-Cardero P, Martínez-Lloreda Á. Revision knee arthroplasty with a rotating-hinge design in elderly patients with instability following total knee arthroplasty. J Clin Orthop Trauma. 2015;6:19–23.
Kouk S, Rathod PA, Maheshwari AV, Deshmukh AJ. Rotating hinge prosthesis for complex revision total knee arthroplasty: a review of the literature. J Clin Orthop Trauma. 2018;9:29–33.
Bingham JS, Bukowski BR, Wyles CC, Pareek A, Berry DJ, Abdel MP. Rotating-hinge revision total knee arthroplasty for treatment of severe arthrofibrosis. J Arthroplasty. 2019;34:S271–6. pii: S0883-5403(19)30117-2.
Rodriguez-Merchan EC. Total knee arthroplasty using hinge joints: indications and results. EFORT Open Rev. 2019;4:121–32.
Buechel FF. Patellar tendon bone grafting for patellectomized patients having total knee arthroplasty. Clin Orthop Relat Res. 1991;271:72–8.
Hanssen AD. Bone-grafting for severe patellar bone loss during revision knee arthroplasty. J Bone Joint Surg Am. 2001;83:171–6.
Ries MD, Cabalo A, Bozic KJ, Anderson M. Porous tantalum patellar augmentation: the importance of residual bone stock. Clin Orthop Relat Res. 2006;452:166–70.
Vince K, Roidis N, Blackburn D. Gull-wing sagittal patellarosteotomy in total knee arthroplasty. Tech Knee Surg. 2002;1:106–12.
Gililland JM, Swann P, Pelt CE, Erickson J, Hamad N, Peters CL. What is the role for patelloplasty with gullwing osteotomy in tevision TKA? Clin Orthop Relat Res. 2016;474:101–6.
Putman S, Boureau F, Girard J, Migaud H, Pasquier G. Patellar complications after total knee arthroplasty. Orthop Traumatol Surg Res. 2019;105:S43–51.
Rodriguez-Merchan EC. Single local infiltration analgesia (LIA) aids early pain management after total knee replacement (TKR): an evidence-based review and commentary. HSS J. 2018;14:47–9.
Rodriguez-Merchan EC, Vaquero-Picado A, Ruiz-Perez JS. Opioid-free total knee arthroplasty? Local infiltration analgesia plus multimodal blood-loss prevention make it possible. HSS J. 2019;15:17–9.
Ortega-Andreu M, Talavera G, Padilla-Eguiluz NG, Perez-Chrzanowska H, Figueredo-Galve R, Rodiiguez-Merchan EC, et al. Tranexamic acid in a multimodal blood loss prevention protocol to decrease blood loss in revision total knee arthroplasty: a cohort study. Open Orthop J. 2016;10:439–47.
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Encinas-Ullán, C.A., Gómez-Cardero, P., Rodríguez-Merchán, E.C. (2020). Revision Total Knee Arthroplasty: Surgical Technique. In: Rodríguez-Merchán, E. (eds) Revision Total Joint Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-030-24773-7_2
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