Revision total knee arthroplasty: what the practicing orthopaedic surgeon needs to know

The number of revision total knee arthroplasties (TKAs) continues to steadily increase. The evaluation of painful and revision TKAs may be challenging for the general orthopaedic surgeon, but a standardized, systematic approach to each patient will allow predictable surgical outcomes. This approach begins with a consistent and thorough preoperative patient evaluation. Revision surgery should not be performed until the etiology of failure of the index arthroplasty is known. The possibility of infection in the revision setting also must be considered because this complication will drastically alter the treatment algorithm. Adjunctive techniques, including the quadriceps snip, the medial collateral ligament slide, and the tibial tubercle osteotomy, can greatly enhance surgical exposure and the efficient removal of components in revision TKAs. A thorough knowledge of the reconstructive options for replacing bone loss is crucial, and the availability of appropriate revision instrumentation is required for surgical efficiency. A concise diagnostic algorithm coupled with clear reconstructive principles will allow more efficient and confident management of a patient with a failed TKA.