Revision total knee arthroplasty.

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.