Total knee arthroplasty (TKA) has proven to be one of the most costeffective procedures that a patient with end-stage knee disease can receive. With improvement in prosthetic design, instrumentation, surgical technique, and rehabilitation, long-term results have been excellent. As a result of the improved functional outcome and an aging population, the number of primary TKAs performed in North America now exceeds the number of primary hip arthroplasties. Concomitant to the increased prevalence of primary TKA, however, there has been a greater need for total knee arthroplasty revision. Although aseptic failure is relatively uncommon, poor surgical technique and inadequate prosthetic design are responsible for most indications for revision knee surgery. In a failed TKA, it is imperative that the surgeon initially defines the mode of failure of the implant. The most common causes of aseptic failure are loosening, with or without component malalignment, polyethylene wear, ligament instability, extensor mechanism insufficiency, and arthrofibrosis. This article highlights tactics in preoperative planning and provides an overview of the rationale behind surgical exposure, implant removal, bone defect appraisal, ligament balancing and augmentation, reimplantation, and wound closure in total knee arthroplasty revision.
© 1999 Lippincott Williams & Wilkins, Inc.