Revision knee surgery: the practical approach

Abstract

Revision total knee arthroplasty (rTKA) is a challenging procedure with often unreproducible results. A step-by-step approach is fundamental to achieving good outcomes. Successful surgery requires a correct diagnosis of the original cause of failure. Only with an accurate and detailed plan can surgeons overcome difficulties presented in this scenario. Any bone loss should be prevented during prosthetic component removal. Efficient tools must be chosen to avoid time-consuming manoeuvres. Joint reconstruction based on a ‘dual-zone’ fixation is essential to provide a long-term survivorship of the implant. The use of relatively short fully cemented stems combined with a biological metaphyseal fixation is highly recommended by authors. Flexion and extension gaps are accurately balanced after the establishment of the tibial platform. Varus-valgus laxity is commonly managed with a condylar constrained prosthesis. If hinged implants are required, a stronger implant fixation is needed to counteract constraints forces.