Essential Surgical Steps for Successful Revision TKA

    In an overview of revision total knee arthroplasty (TKA) at ICJR’s 6th Annual Revision Hip & Knee Course, Rafael J. Sierra, MD, from Mayo Clinic in Rochester, Minnesota, shared 8 keys points for planning for a successful procedure.

    Key Point #1: Know why the knee failed by assessing component position, alignment, rotation, and stability. Rule out infection.

    Key Point #2: Rule out other sources of pain and functional impairment, including hip or back pathology; vascular, soft tissue, or neurologic issues; and stress fracture.

    Key Point #3: Be realistic with the patient in terms of expectations and possible complications of surgery. The success rate is typically highest, Dr. Sierra said, with loosening or wear and lowest for pain of unknown origin.

    Key Point #4: Get the operative notes for the index arthroplasty to help with planning the revision, including the approach. The operative note will also indicate if there’s a reason the implant is malaligned; the surgeon may have done it on purpose.

    Key Point #5: Ensure adequate exposure – a revision is no time for a minimally invasive approach. An extensile exposure may be needed, so the surgeon should ensure that no bridges are burned on the initial exposure, Dr. Sierra said.

    Key Point #6: Obtain a stable, balanced knee by restoring the joint line (if possible), balancing the gaps, and ensuring stable tibial and femoral components. A stable knee starts with safe implant remove, Dr. Sierra said, which aims to preserve as much bone as possible.

    Key Point #7: Don’t forget about the patella. Options for managing the patella include simple revision, resection arthroplasty, and patella bone grafting or tantalum patella for severe bone loss. Patellectomy is not an option, Dr. Sierra said.

    Key Point #8: Have a plan for rehabilitation, which will be dictated by the exposure and implant fixation.

    Click the image above to watch Dr. Sierra’s presentation and learn more about the steps for a successful revision TKA.


    Dr. Sierra has disclosed that he receives royalties and research support from and is a consultant for Zimmer Biomet and Link Orthoapedics.