Revision after total knee arthroplasty.

Revision of a total knee arthroplasty is most frequently required because of prosthetic loosening, instability, and failure to restore proper axial alignment. The instability and improper axial alignment may result in abnormal stresses that predispose to component loosening, component failure, and stress fracture of the tibia. Therefore, it is essential to obtain correct axial alignment and soft tissue balance at the time of the initial arthroplasty. Approximately two thirds of those knees having one or more revisions of their arthroplasty will have a satisfactory result. One third will have an unsatisfactory result related to continued pain or restricted motion, or both. We have reported the results in 142 knees, 95 of which had one revision, 37 of which had two revisions, and 10 of which had three revisions. It is essential in such revisions, in our opinion, to thoroughly debride the knee, restore quadriceps balance, establish the correct alignment, minimize bone loss, and use the least possible constraint in the prosthesis combined with an external brace for three to six months.