Revision knee surgery techniques

Abstract

Revision total knee arthroplasty (rTKA) is a challenging, complex procedure. A comprehensive understanding of the anatomy, challenges and pitfalls is essential to achieve a good outcome for the patient.This review discusses the determinants of good outcomes of rTKA. These include, among other factors, the choice of the surgical approach, removal of the components, adequate reconstruction of the joint line and posterior condylar offset and the use of offset stems, as well as choosing the appropriate level of constraint.The modularity of many modern knee revision systems can help to address such issues as anatomical mismatch, gap balancing and malalignment.A well-planned surgical approach must be used in rTKA. A thorough understanding of related knee anatomy is essential.The incidence of joint-line elevation after rTKA is high. Contralateral radiographs, as well as algorithms based on the relationship between bony landmarks and the joint line, can help to reconstruct a physiological joint line during rTKA.Modularity added to systems, such as offset stems, are useful enhancements that may further improve the reconstruction of the anatomy.There are several options for managing the patella, with the best choice depending on the status of the patellar component and residual bone stock.Cite this article: Thienpont E. Revision knee surgery techniques. EFORT Open Rev 2016;1: 233-238. DOI: 10.1302/2058-5241.1.000024.

Association of Anesthesia Type with Postoperative Outcome and Complications in Patients Undergoing Revision Total Knee Arthroplasty

“…From a surgical standpoint, revision procedures are likely more complex and difficult than primary procedures. 4 Despite these challenges, our results-after adjusting for confounding variables from patient's medical history and perioperative information-show similar results as demonstrated in multiple previous studies regarding the association of regional anesthesia for primary TKA with reduced rates of any complication, perioperative blood transfusion, and extended length of stay compared with general anesthesia. 12,16 Improving overall surgical outcomes is an important step to decreasing patient burden and increasing patient satisfaction.…”

“…3 Revisions are often more complex procedures with higher complication and mortality rates, making it crucial to explore perioperative factors such as anesthesia that may reduce subsequent complications and improve health outcomes. [4][5][6] Anesthetic care has long been synonymous with risks, but recently it has been recognized as a model for patient-safety improvements by developing systematic ways to monitor and limit adverse outcomes. [7][8][9] In the field of orthopedics, there has recently been a growing interest in regional anesthesia techniques due to an overall increase in volume of procedures and the numerous comparative benefits.…”

Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from “The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man”

“…5-year revision rates diminished across the study. It has been an important effort to reduce revision rates because the procedure is more complicated to perform 41 . Surveillance of knee replacement revisions, using joint registries, have long been the main measure of primary surgical success/failure until PROMs were also used to assess outcomes 42 .…”

Impact of Tibial Tubercle Osteotomy on Final Outcome in Revision Total Knee Arthroplasty: Our Experience and Technique in Pakistan

“… 3) Adequate exposure during revision TKA is one of the challenges among arthroplasty surgeons because of underlying contracture of the extensor mechanism or limited mobility, which might cause difficulty in eversion of the patella and could lead to a rupture of the patellar tendon from its insertion. 4 5) There are various extensile approaches used during revision TKA in order to provide adequate exposure and allow easy implant removal such as the quadriceps snip approach (QS), 6) quadriceps turndown technique, 7) V-Y quadricepsplasty, 8) and tibial tubercle osteotomy (TTO). 9) Among all these approaches, the TTO and QS are commonly performed in complicated revision cases.…”