Abstract
Understand the nature of the problem. Revision TKR is a major undertaking and should be focused on problem solving. Know the problem!- Pain is not a diagnosis. Review history of problem. Think of possibilities: Infection, loosening, instability, stiffness, malalignment, poor kinematics.
Ensure an adequate workup - History, Exam; Imaging: Radiographs: consider long alignment films, MR for soft tissue issues: Clunk, recurrent hemarthroses; CT scan: Remains gold standard for rotational alignment. Labs: CBC, ESR, C-reactive protein. Aspiration: Cell count, Culture.
Assessment of where the patient is currently!
Synthesise a working diagnosis and formulate a provisional plan. Revise “part of knee”: you better know what's in there! Revise “all of knee”.
How will you get there? Think old incisions
How will get the parts out? What tools do you need? High speed burrs / diamond tip wheel /long thin saw blades; Osteotomes; Implant specific tools.
Once everything is out: What do you have left? Soft tissue defects, Bone defects.
How to “rebuild”: Constraint for soft tissue defects, Stems for mechanical stability, Cones / augments / bone graft for osseous defects; Fixation: Cement, Cementless.
