Abstract
Pre-operative planning in revision total knee replacement is important to simplify the surgery for the implant representative, operating room personnel and the surgeon. In revision knee arthroplasty, many implant options can be considered. This includes cemented and cementless primary and revision tibial and femoral components, with posterior cruciate retention or resection, and either with no constraint, varus/valgus constraint, or with rotating hinge bearings. One may also need femoral and tibial spacers or bulk allograft. It is important to pre-operatively determine which of these implants you may need. If I ask my implant representative to “bring everything you've got, just in case,” I will get 23 pans of instruments, 24 bins of implants composed of 347 boxes of sterile implants, and chaos for everyone.
Occasionally, one may not need to revise all components, so the surgeon needs to be familiar with the implants they are revising. Consider having some or all compatible components available.
Most revision knee implants can be conservatively cemented with diaphyseal engaging press-fit stems. Most importantly, pre-operative physical examination and radiographs are used to determine the status of the collateral ligaments, so that the appropriate constrained implants will be available at surgery. Radiographs will also show the amount and location of bone loss. This will determine if revision type implants, spacers or bone graft will be needed. Radiographically, one can determine the appropriate joint line position relative to the existing femoral component to simplify the surgery. Excellent pre-operative planning will minimises the need to bring in an excessive number of instruments and implants. It will help assure that the patient has a stable revision knee and simplify the surgery for all participants.
