Results of revision total knee arthroplasty

Purpose of review: The complexity and individuality of failed total knee arthroplasties make revision surgery challenging to the surgeon and to those who assess patient outcomes and results. This review presents recent information on the results of total knee revision arthroplasty. Recent findings: Outcome studies have shown that revision arthroplasty improves patient function and pain comparable to that of primary knee arthroplasty. The stiff total knee arthroplasty also can be significantly improved by revision arthroplasty. Technical advances, such as uncemented stems for securing revision implants, impaction bone grafting techniques, and custom metal augmentation (for reconstruction of bone defects), have improved revision total knee systems and outcome at early and intermediate follow-up. However, the advantage of modular primary implants has been questioned, and because selective component revision (such as isolated revision of the patella, tibial tray, or polyethylene liner) has a significantly high failure rate necessitating re-revision, it should be limited to specific indications. Malalignment and instability are best treated with revision of all involved components. Summary: The results of revision total knee arthroplasty are improving as surgeons begin to understand the problems associated with particular revision cases and to use technical advances in implant design and bone loss repair. Selective component revision has a high failure rate and should be limited to very specific situations. The failure of modularity to aid in revision surgery makes the use of monoblock primary tibial components attractive.