Preoperative planning for revision total knee arthroplasty:avoiding chaos.

Use of preoperative planning is important in avoiding an unstable revision total knee arthroplasty. Physical examination should determine the status of the collateral ligaments so that implants with appropriate constraint are made available. Radiographic examination should determine if bone loss is present and whether primary or revision implants will be needed. Preoperative determination of the joint line position will simplify the surgery and facilitate flexion/extension space balancing. Three hundred sixty-five revision total knee arthroplasty surgeries were performed from 1987 to 2003. Of those, 82% were performed with unconstrained implants. Ten percent of the knees required varus/valgus constraint and 8% knees used rotating hinge components. Use of preoperative planning techniques resulted in postoperative stability in 99% of the revision total knee arthroplasties performed.