Abstract
To wake up in the morning facing a complex total hip revision can be unpleasant. Modern designs have greatly facilitated dealing with the most difficult revision situations both on the acetabular and femoral side. The surgeon faces blood loss, dislocation, infection, and a litany of other potential complications. Our advances in total hip revision have been outstanding but can pose very complex issues.
Total knee revision on the other hand is easier. The surgeon needs to ask a series of questions pre-operatively and intra-operatively. Pre-operatively, one must know the mechanism of failure. You also need to know “what is missing” in terms of skin, soft tissue, extensor mechanism, bone and ligaments.
Intra-operatively, the surgeon must know the difference between the flexion and extension gap, the position of the joint line, the extent of the bone loss and whether it is load bearing or non-load bearing, the ligamentous stability and the intramedullary shaft. Most modern knee revision designs allow the surgeon to create a paradigm to deal with all of these potential problems.
There, of course, are complex problems of malalignment, periprosthetic fracture and other deformities that add a level of complexity but most of these can be dealt with using standard revision designs without requiring custom prostheses.
