CHALLENGING CASES: Correcting Malalignment in TKA

    When performing a primary total knee arthroplasty (TKA), one of the surgeon’s goals is to properly align the components in all planes, using a reproducible and predictable technique.

    But errors can occur, leaving the patient unhappy with the procedure and necessitating revision surgery to correct malalignment, one of the many indications for a revision procedure.

    At the ICJR South/RLO Spring Hip & Knee Course, Michael P. Bolognesi, MD, from Duke University Medical Center in Durham, North Carolina, reviewed his tips for evaluation and surgical management of patients who require a revision TKA due to malalignment.

    When evaluating patients who present with a failed TKA, be sure to:

    • Perform a complete preoperative work-up with physical examination and radiographs, including long standing This will help the surgeon determine if the components are malaligned.
    • Rule out infection as a possible cause of the problem.
    • Obtain a CT scan as needed to better evaluate rotational alignment of the tibia and femur.
    • Use the findings of the preoperative evaluation to determine if the problem can be corrected surgically.

    When malalignment is found to be the cause of a TKA failure, Dr. Bolognesi follows this sequence in his revision procedures:

    • Expose the joint and remove the liner to obtain better exposure.
    • Assess the flexion gap to determine if there is a flexion malalignment issue.
    • Removing the existing implants.
    • Start on the tibial side, ensuring good positioning of the tibial component and appropriate restoration of the joint line. This creates a “base” for reconstructing the femur.
    • Next, rebuild the femur. Assess the reconstruction with trial components before cementing the final components in place.

    Dr. Bolognesi advised meeting attendees to make sure to correct the malalignment in all planes and not to forget about simple things like adequate fixation.

    Click the image above to watch Dr. Bolognesi’s presentation and learn more about revision TKA for malalignment.


    Dr. Bolognesi has no disclosures relevant to this presentation.