Revision knee replacement presents a complex surgical challenge to the orthopedic surgeon. Every phase of the revision procedure must be approached with careful planning to effect a sound functional result. Diagnosis of failure must be accurate, particularly to eliminate the presence of indolent infection. Mechanical causes of failure provide special problems of soft tissue balancing and bone loss and these must be thoroughly evaluated prior to proceeding with revision surgery. Comprehensive examination of the patient provides important preoperative information on the nature and utility of prior incisions, soft tissue deficits that may be problematic with wound closure, and ligamentous instability. Radiographs must be thoroughly evaluated to determine: (1) possible technical problems with implant removal, (2) prosthetic instability, (3) bone deficits that will need reconstruction after implant removal, and (4) patellofemoral failure and cause. Only after this type of comprehensive review can an operative plan be developed that will globally resolve all problem areas in the surgical treatment of the failed total knee replacement.
KeywordsBone Loss Knee Replacement Total Knee Replacement Tibial Component Extensor Mechanism
Unable to display preview. Download preview PDF.
- 1.Donaldson, WF III, Sculco TP, Insall JN, Ranawat CS. Total condylar III prosthesis: long term follow-up study. Clin. Orthop. 226:22–30, 1988.Google Scholar
- 2.Elia EA, Lotke P: Results of revision total knee arthroplasty associated with significant bone loss. Clin. Orthop. 271:114–122, 1991.Google Scholar
- 3.Goldberg, VM, Figgie MP, Figgie HE, Sobel M. The results of revision total knee arthroplasty. Clin. Orthop. 226:8692, 1988.Google Scholar
- 4.Hanssen, AD, Rand JA. Comparision primary and revision total knee arthroplasty using kinematic stabilizer prosthesis. J. Bone Joint Surg. 70A: 491–499, 1988.Google Scholar
- 5.Hunter GA, Cameron HU, Welsh RP. Bailey WH. The natural history of the failed knee replacement. Orthop. Trans. 4:389, Abstract, 1980.Google Scholar
- 6.Rand JA, Bryan RS. Results of revision total knee arthroplasties using condylar prostheses. J. Bone Joint Surg. 70A:738–745, 1988.Google Scholar
- 8.Rosenberg AG, Vemer JJ, Galante JO. Clinical results of total knee revision using the Total Condylar III proshesis. Clin. Orthop. 273:83–90, 1991.Google Scholar
- 9.) Sculco, TP. Total Condylar III prosthesis in ligament instability. Orthop. Clin. North Am. 20:221–227, 1989.Google Scholar
- 10.) Stuart, MJ, Larson JE, Morrey BF. Reoperation after condylar revision total knee arthroplasty. Clin. Orthop. 286:168–173, 1993Google Scholar
- 12.) Vince, KG, Long, W. Revision knee arthroplasty. The limits of press fit medullary fixation. Clin. Orthop. 317:172–177, 1995.Google Scholar
- 12.Whitesides, LA, Ohl, MD, Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty, Clin. Orthop. 260:6–9, 1990.Google Scholar