TKA Revision 27487

CPT Coding Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms: revision TKA, revision total knee arthroplasty, revision knee replacement

TKA Revision CPT

TKA Revision Indications

TKA Revision Contraindications

TKA Revision Alternatives

  • A

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

  • Nonuion
  • Infection
  • Painful hardware
  • Compartment Syndrome
  • CRPS
  • 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

  • Post-op:
  • 7-10 Days:
  • 3 Weeks:
  • 6 Weeks:
  • 2 Months:
  • 3 Months:
  • 6 Months:
  • 1Yr:

TKA Revision Outcomes

  • (R

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.