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. Cite this article: EFORT Open Rev 2021;6:495-500. DOI: 10.1302/2058-5241.6.210018

Fungal Prosthetic Joint Infection in Revised Knee Arthroplasty: An Orthopaedic Surgeon’s Nightmare

“…The number of primary TKAs doubled from 1991 to 2010 in USA, while it is estimated to increase even more by 2050 [ 6 ]. Due to the large number of patients undergoing TKA, as well as the expansion of life-expectancy, the need for revision reconstruction surgeries has also been increased [ 7 ]. The main causes of prosthetic failure include infection, aseptic loosening, and periprosthetic fractures [ 5 , 6 , 7 ].…”

“…Revision surgery is a very demanding procedure, generating outcomes inferior to those of primary knee arthroplasty and with higher risk of complications [ 7 ]. The surgeons have to handle various and different technical challenges regarding surgical exposure and approach, bone loss management as well as the appropriate implant selection [ 7 ].…”

“…Early PJI cases most commonly occur due to intraoperative contamination. Delayed and late presentations are usually characterized by progressive, persistent pain, and are almost always hematogenous in origin [ 7 , 8 , 9 ]. Regarding the risk factors for PJI, operative time, tourniquet time, cement type, diabetes, obesity, American Society of Anesthesiology (ASA) score, and blood transfusion requirement have been reported [ 9 ].…”

The role of antibiotic calcium sulfate beads in acute periprosthetic knee infection: a retrospective cohort study

“…The incidences of post-TKA PJI reportedly ranged from 0.5 to 2% [ 2 ]. Currently, surgical management remains challenging and has a major impact on the patients [ 3 ].…”

Tibial Tubercle Screw Fixation on Custom Metaphyseal Cone: Surgical Tip in Severe Metaphyseal Tibia Bone Loss

“…Adequate exposure in revision total knee arthroplasty (TKA) is mandatory for the procedure to be a success [ 1 ]. However, the exposure in revision and especially in the case of re-revision might be technically demanding due to the contraction of the extensor mechanism and surrounding fibrotic tissue envelope from previous surgeries [ 2 ].…”