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J Am Acad Orthop Surg, Vol 16, No 8, August 2008, 442-454.
© 2008 the American Academy of Orthopaedic Surgeons
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Revision Total Knee Arthroplasty

Douglas A. Dennis, MD, Daniel J. Berry, MD, Gerard Engh, MD, Thomas Fehring, MD, Steven J. MacDonald, MD, Aaron Glen Rosenberg, MD and Giles Scuderi, MD

Dr. Dennis is Adjunct Professor, Department of Biomedical Engineering, University of Tennessee, Knoxville, TN; Assistant Clinical Professor, University of Colorado Health Sciences Center, Denver, CO; Clinical Director, Rocky Mountain Musculoskeletal Research Laboratory, Denver; and Co-founder and Senior Partner, Colorado Joint Replacement, Denver. Dr. Berry is Professor, Orthopaedic Surgery, Mayo Clinic College of Medicine, Rochester, MN. Dr. Engh is Director, Knee Research, Anderson Orthopaedic Research Institute, Alexandria, VA. Dr. Fehring is Orthopaedic Surgeon, OrthoCarolina Hip and Knee Center, Charlotte, NC. Dr. MacDonald is Professor, Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada, and Chief of Surgery, Chief of Orthopaedics, London Health Sciences Centre, London, Ontario. Dr. Rosenberg is Professor of Surgery and Director, Adult Reconstructive Orthopaedics, Rush Medical College, Rush University, Chicago, IL. Dr. Scuderi is Director, Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, NY.

Dr. Berry or a member of his immediate family has received research or institutional support from Zimmer, DePuy, and Stryker, and has received royalties from DePuy. Dr. Engh or a member of his immediate family has received research or institutional support from Inova Health Care Services and has received royalties from DePuy. Dr. Fehring or a member of his immediate family has received research or institutional support and royalties from and serves as a consultant to or is an employee of DePuy. Dr. Rosenberg or a member of his immediate family has received research or institutional support, has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel), and has received royalties from Zimmer, and has stock or stock options held in Zimmer. Dr. Scuderi or a member of his immediate family has received royalties from, has stock or stock options held in, and serves as a consultant to or is an employee of Zimmer. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Dennis and Dr. MacDonald.

This Symposium was presented at the AAOS 73rd Annual Meeting, Chicago, IL, March 22-26, 2006.

Reprint requests: Dr. Dennis, Colorado Joint Replacement, 2535 South Downing Street, #100, Denver, CO 80210.

Revision total knee arthroplasty presents numerous technical challenges and decisions for the operating surgeon. Preoperative planning includes critically reviewing radiographs and ordering necessary equipment, including prosthetic components, extraction devices, and bone graft materials. In some cases, surgical exposure requires the use of extensile exposure techniques. Component removal is facilitated by the use of appropriate tools (eg, specialized osteotomes) as well as by the patience to ensure preservation of host bone. Bone loss is managed with bone grafts or prosthetic augmentation. Attention to balancing the flexion and extension gaps is essential to avoid problems with instability as well as excessively constrained prosthetic components. Intramedullary stem extensions improve long-term clinical results. Intraoperative extensor mechanism complications can be avoided with meticulous surgical technique; late complications may require surgical intervention.






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