Revision Total Knee Arthroplasty

Abstract

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.