Preface

Total knee arthroplasty has become an established and highly successful procedure for the treatment of arthritis of the knee. The techniques and implant designs have evolved over the past 40 years to a highly sophisticated level, which produces significant reduction in pain and marked improvement in patient function. The initial emphasis in total knee arthroplasty research was directed at implant improvement with multiple sizing, articular geometries, and better and simpler instrumentation. More recent advances have evolved in less radical surgical technique and more effective pain management. These newer techniques have led to more rapid rehabilitation and return to most activities. Over 1 million total knee replacements are being performed globally and the vast majority are being performed by general orthopedic surgeons doing o25 knees per year. It is paramount that the initial procedure be accomplished correctly and that soft tissues are well balanced, the knee is aligned properly, and the fixation method is done well. Failure to achieve these goals will lead to implant failure, loosening, and the need for revision. There have been great advances in knee revision surgery, and the implants are needed to deal with bone deficiency and soft tissue insufficiency. Revision knee replacement surgery must be well planned and 41 option must be available to the surgeon at surgery. The revision procedure itself can be divided into different segments, each requiring expertise and careful attention to detail. First, the exposure of the knee must be performed well to allow full visualization and radical removal of scar may be necessary in a fibrotic stiff knee. Second, the implant and cement must be remove with care and with special instruments (eg, ultrasonic instruments and high speed burrs) and great attention must be paid to prevent further loss of bone at implant removal. The third phase is the reconstruction of soft tissues and bone deficits after implant removal. Augmentations may be used on the femoral and tibial components if needed for bone loss and implants with increasing constraint can be employed if there is significant loss of soft tissue stability. The knee must be stable, well aligned, and seated on satisfactory bone after these techniques and implant selection. Fourth, the extensor mechanism must be mobilized if the knee is stiff and balanced to allow proper tracking of the patella. This issue of Techniques in Orthopaedics deals in significant detail in all of the problems confronting the revision knee surgeon. The issue takes the reader through the causes of failure, operative technique for exposure, soft tissue and bone deficit management, and implant selection. The extensor mechanism techniques are presented and in the final chapter the results with revision knee replacement are presented. All the authors bring a global and experienced view to these revision considerations. I have endeavored to present the state of the art of revision knee replacement in this volume and believe it will be a helpful guide to the issues and solutions in revision knee replacement surgery.