synonyms: revision TKA, revision total knee arthroplasty, revision knee replacement
TKA Revision CPT
TKA Revision Indications
TKA Revision Contraindications
TKA Revision Alternatives
TKA Revision Pre-op Planning
- Generally obtain ESR and CRP as part of pre-op workup to evaluate for infection. If elevated aspiration is indicated prior to surgery.
TKA Revision Technique
- Mid-line longitudinal incision. Use the most lateral longitudinal parapatellar incision when previous multiple incisions are present. (Vince KG, ICL 1993;42:325)
- Consider rectus snip for difficult exposure: no effect on motion, extensor lag or strength at long-term follow-up. (Meek RM, Greidanus NV, McGraw RW, Masri BA. The extensile rectus snip exposure in revision of total knee arthroplasty. J Bone Joint Surg Br. 2003 Nov;85(8):1120-2)
- Consider tibial tubercle osteotomy (TTO) for exposure in a stiff knee. TTO has a 5% complication rate. TTO post-op care: full weight-bearing, range of motion as tolerated. (Young CF, Bourne RB, Rorabeck CH. Tibial tubercle osteotomy in total knee arthroplasty surgery. J Arthroplasty. 2008 Apr;23(3):371-5. Dennis DA, Berry DJ, Engh G, Fehring T, MacDonald SJ, Rosenberg AG, Scuderi G. Revision total knee arthroplasty. J Am Acad Orthop Surg. 2008 Aug;16(8):442-54.)
- Massive tibial defects-tibial bone loss(AORI types 2 and 3): metaphyseal fixation with metallic trabecular metal cones or metaphyseal porous coated sleeves. Other options = cement, structural allograft. Generally metal augments for older patients with poor bone quality. Consider structual allograft for younger patients. (Clatworthy MG JBJS 2001;83A:404-411)
- Medial proximal tibia soft tissue defect: Medial gastrocnemius rotational flap. Must mobilize medial sural arteries to ensure flap remains vascularized (Busfield BT, Clin Orthop Relat Res. 2004 Nov;(428):190-7).
- MCL laxity: Consider MCL reconstruction in young, active patients. Generally treated with rotating-hinge TKA. (Hernández-Vaquero D, Clin Orthop Relat Res. 2010 May;468(5):1248-53, Barrack RL, J Arthroplasty. 2000 Oct;15(7):858-66.)
TKA Revision Complications
- Painful hardware
- Compartment Syndrome
- DVT / PE
- Heterotopic Ossification
- Stiffness following total knee arthroplasty: deep infection should be ruled out first. Other causes of TKA stiffness are overstuffing of the patella, malpositioning of the components, ligamentous imbalance, genetic predisposition, aggressive arthrofibrosis;. Outcome of revision TKA for stiffness is poor if no reason for stiffness is determined. (Kim J, J Bone Joint Surg Am 2004;86-A(7):1479-1484.)
TKA Revision Follow-up care
- 7-10 Days:
- 3 Weeks:
- 6 Weeks:
- 2 Months:
- 3 Months:
- 6 Months:
TKA Revision Outcomes
TKA Revision Review References
- Vince KG: Revision knee arthroplasty technique. Instr Course Lect 1993;42:325-339.
- Song SJ, Detch RC, Maloney WJ, Goodman SB, Huddleston JI 3rd. Causes of instability after total knee arthroplasty. J Arthroplasty. 2014 Feb;29(2):360-4.
- Abdel MP, Pulido L, Severson EP, Hanssen AD. Stepwise surgical correction of instability in flexion after total knee replacement. Bone Joint J. 2014 Dec;96-B(12):1644-8.
- Parratte S, Pagnano MW. Instability after total knee arthroplasty. J Bone Joint Surg Am. 2008 Jan;90(1):184-94.
- Haidukewych GJ, Hanssen A, Jones RD. Metaphyseal fixation in revision total knee arthroplasty: indications and techniques. J Am Acad Orthop Surg. 2011 Jun;19(6):311-8. Review.
- Long WJ, Scuderi GR. Porous tantalum cones for large metaphyseal tibial defects in revision total knee arthroplasty: a minimum 2-year follow-up. J Arthroplasty. 2009 Oct;24(7):1086-92.
- Meneghini RM, Lewallen DG, Hanssen AD. Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg Am. 2008 Jan;90(1):78-84.
- Beckmann NA, Mueller S, Gondan M, Jaeger S, Reiner T, Bitsch RG. Treatment of severe bone defects during revision total knee arthroplasty with structural allografts and porous metal cones-a systematic review. J Arthroplasty. 2015 Feb;30(2):249-53.
- Markovich GD, Dorr LD, Klein NE, McPherson EJ, Vince KG. Muscle flaps in total knee arthroplasty. Clin Orthop Relat Res. 1995 Dec;(321):122-30.
- Haidukewych GJ, Hanssen A, Jones RD. Metaphyseal fixation in revision total knee arthroplasty: indications and techniques. J Am Acad Orthop Surg. 2011 Jun;19(6):311-8.