Abstract
The designs available today have greatly improved our ability as surgeons to perform successful total knee revision surgery. However, as more and more knee replacements are in service for longer periods of time, the numbers of revisions have increased and have required us as surgeons to address challenging problems including infection, instability and bone loss from wear, osteolysis and loosening.
Understanding the problems needed to be addressed is paramount. Careful preoperative planning is key. Knowing the cause of failure and the aspects of reconstruction that need to be addressed including skin, soft tissues, extensor mechanisms, bone and ligament loss is critical.
Intraoperatively, understanding and applying principles related to establishing joint lines, balancing flexion extension gaps, addressing bone loss and ligament instability and constructing stable knee replacements with the use of stabilising implant articulations, bone deficiency reconstruction with augments and grafts as well as cones and sleeves, and stems for implant stability is also essential.
Postoperatively, rehabilitation and follow-up must be tailored to the individual patient because of the marked nuances of construct in the various revision scenarios.
