Four Challenges in Revision Total Knee Arthroplasty: Exposure, Safe and Effective Component Removal, Bone Deficit Management, and Fixation.

With utilization of both primary and revision total knee arthroplasty projected to increase in coming decades particularly in younger, more active patients, a determination of best surgical practices is vital to meet the burden of demand. Four challenges in surgical techniques for revision total knee arthroplasty include surgical exposure, careful removal of components, bone deficit management, and fixation options. Surgical exposure may be more complicated in patients presenting for revision who have a history of multiple prior surgeries, infection, scar tissue formation, stiffness, ligamentous deficiency, or vascular compromise. Removal of previous implants while preserving bone stock and ligamentous stabilizers requires adequate exposure of interfaces and visualization, and is facilitated with a variety of tools and techniques. Treatment options for management of bone deficits have expanded in recent years to include a wide range of porous metal sleeves, cones, and augments, in addition to the traditional arsenal of screws, cement, bone graft, metallic augments, offset adapters, and stems in various lengths and geometries. Stem fixation may be noncemented, cemented, or hybrid, with the goal of the stems to load share and enhance the mechanical stability of the reconstruction.