Abstract
Revision TKR is a challenging surgical procedure that requires considerable pre-operative evaluation and planning. The diagnostic evaluation for the presence of periprosthetic sepsis has been well described and is of paramount importance. Optimal results of revision TKR mandate that the etiology of failure, and reason for revision, be clearly understood, since the outcome of revision TKR for unexplained pain has been disappointing.
Physical examination should include a careful assessment of range of motion, ligament stability, quality of the soft tissues around the knee and the location of any prior incisions around the knee. The above information provides valuable information about any potential difficulties with surgical exposure, selection of the safest surgical incision, potential problems with soft tissue coverage and selection of an implant with the proper degree of constraint.
Plain radiographs should be carefully evaluated for fixation, alignment, osteolysis and extent of bone deficiency around each component. This information is essential in order to develop a strategy for removal of existing implants and cement, obtaining satisfactory fixation of a new implant and managing bone deficiencies encountered at the time of surgery using a variety of stems, augments and bone grafts.
The goals of revision TKR are simple to state but difficult to obtain: stable implant fixation, a healed surgical wound without infection, restoration of alignment, stability and a functional range of motion. Despite the most conscientious pre-operative planning, one must be prepared for the unexpected and any surgical plan requires a sound “back-up” plan.
