Abstract
Revision total knee arthroplasty (TKA) can pose significant challenges. Successful reconstruction requires a systematic approach with the ultimate goal being a well fixed and balanced knee prosthesis. Careful preoperative planning is necessary for safe exposure, component removal, and appropriate management of bone loss during revision knee surgery.
Prior to surgery, the cause of failure must be understood. Revision TKA without a clear diagnosis has been shown to lead to predictable poor results. A careful history and physical examination for both intrinsic and extrinsic causes of knee pain need to be performed. An ESR and C-reactive protein should be obtained in every patient with a painful TKA and in cases of serologic abnormalities, a joint aspiration performed.
The integrity of the collateral ligaments and the degree of anticipated bone loss at the time of revision needs to be established. In cases of severe collateral ligament deficiency, the need for constrained or hinged knee implants should be anticipated. Plain radiographs are needed to evaluate present component position, loosening, and osteolysis. Oblique radiographs and advanced imaging (i.e. CT or MRI) have been shown to more accurately quantify the severity of lysis compared to standard radiographs. This careful assessment can help prepare for the need of special implants, stems, wedges, or augments.
Finally, patient risk stratification and medical co-management can help minimise complications following revision TKA. Optimization of potentially modifiable risk factors such as glycemic control, BMI, and preoperative hemoglobin can reduce perioperative morbidity and complications.
