Knee revision surgery, which is also known as revision total knee arthroplasty, is a procedure in which the surgeon removes a previously implanted artificial knee joint, or prosthesis, and replaces it with a new prosthesis. Knee revision surgery may also involve the use of bone grafts. The bone graft may be an autograft, which means that the bone is taken from another site in the patient’s own body; or an allograft, which means that the bone tissue comes from another donor.
I use a 12 step approach as advocated by Dr. Robert Booth.
It is based on asking yourself different questions.
How bad is it?
- Wait one year
- See no patients without a note/call
- What is the social-economic situation?
- Is there an infection?
What went wrong?
- Rule out infection
- Do a full physical exam, check instability
- Get old op-note, is the bone weak
- If unsure, do not do it
- No to “exploratory” surgery
- There is always more than one problem
Can I fix it?
- Deformity – yes / pain – no
- Instability – yes / stiffness – no
- Likelihood of improvement
- Beware of single component exchanges
Do I have the resources?
- OR time
- Theatre personnel
- Pathology
- Full knee system
- Allied staff post op
Plan vs. planning
- Keep it simple
- Play the odds, rotation, instabilities
- Reduce the variables
What approach to use?
- Use old incisions
- More (open) is better
- Full synovectomy
Assessing the issues.
- Was I correct?
- Static vs. dynamic
- What is the soft tissue competence?
Removal of the old parts.
- Save all bone
- Preserve rims – contain defects
- Work quickly – limit the biological insult
Assessment before cutting.
- Bone / STB loss
- Old joint line
- Rotational guides
Reconstructing the tibia.
- Tibia first
- Flexion first
- Establish base
Reconstructing the femur.
- Secondly the femur – think stems
- Restore offset
- Use soft tissues on bones
Before you go?
- Protect the exstensor
- Did I solve all the issues?
- Post-op protocol
