Revision knee surgery techniques

Abstract

Revision total knee arthroplasty (rTKA) is a challenging, complex procedure. A comprehensive understanding of the anatomy, challenges and pitfalls is essential to achieve a good outcome for the patient. This review discusses the determinants of good outcomes of rTKA. These include, among other factors, the choice of the surgical approach, removal of the components, adequate reconstruction of the joint line and posterior condylar offset and the use of offset stems, as well as choosing the appropriate level of constraint. The modularity of many modern knee revision systems can help to address such issues as anatomical mismatch, gap balancing and malalignment. A well-planned surgical approach must be used in rTKA. A thorough understanding of related knee anatomy is essential. The incidence of joint-line elevation after rTKA is high. Contralateral radiographs, as well as algorithms based on the relationship between bony landmarks and the joint line, can help to reconstruct a physiological joint line during rTKA. Modularity added to systems, such as offset stems, are useful enhancements that may further improve the reconstruction of the anatomy. There are several options for managing the patella, with the best choice depending on the status of the patellar component and residual bone stock.