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Differences Between Re-Revision Total Knee Arthroplasty and Primary Revision Total Knee Arthroplasty

March 01, 2019

Contributors: Davide E Bonasia, MD; Matteo Bruzzone, MD; Umberto Cottino; Federico Dettoni, MD; Roberto Rossi, MD; Federica Rosso, MD; Federica Rosso, MD

2019 HONORABLE MENTION The number of revision total knee arthroplasty (TKA) procedures is increasing because of the increased number of primary TKA procedures that are performed, especially in young patients. Consequently, the number of rerevision TKA procedures also is increasing. In patients undergoing revision TKA, the main causes of failure are insert wear and aseptic loosening. Conversely, in patients undergoing rerevision TKA, the main reason for revision is infection. Rerevision TKA is a complex procedure. Accurate preoperative planning, including a complete clinical and historical evaluation as well as radiographs and CT scans to assess bone loss, is essential to achieve a good result. Despite appropriate preoperative planning, surgeons should have every solution available for problems that may occur during rerevision TKA. The basic principles of revision TKA, including the three-step technique, can be used in rerevision TKA. Various problems may occur during rerevision TKA. Implant removal may be difficult because of the presence of stems. In some patients, dedicated instrumentation may be required for hinge, component, or cement removal. In most rerevision TKA procedures, a highly constrained implant is necessary because of bone loss and ligamentous instability. Good implant fixation is mandatory in all revision TKA procedures to obtain a good outcome; however, solid fixation in the epiphysis, metaphysis, and diaphysis may be necessary in patients with poor bone quality who undergo rerevision TKA. Severe bone loss and associated poor bone quality often are present in patients who undergo rerevision TKA. Tantalum cones may help fill metaphyseal bone loss and improve fixation in this zone. The patella in patients undergoing rerevision TKA may need to be revised with a standard or tantalum component. This video discusses tips and tricks for rerevision TKA.

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