Preoperative Evaluation, Planning, and Templating for Revision Total Knee Arthroplasty

Timothy S. Brown

Daniel J. Berry

Preoperative Evaluation

Establish a clear diagnosis. Understand what has failed and what you are trying to fix.
Anticipate challenges related to exposure, implant removal, bone reconstruction, knee stability, and the extensor mechanism.
The goal is to solve the patient’s problem without creating new problems. A successful revision total knee arthroplasty (TKA) will be performed by gaining a well-fixed and durable, well-aligned, stable knee. At the same time, further bone loss should be minimized and soft tissues and the extensor mechanism protected.

Physical Examination

Evaluate old incisions: Which one will you use? Most of the time the most lateral useable incision or the most recent longitudinal incision is chosen. If wound problems are anticipated, consider consultation with the plastic surgery team (Figure 58.1).
Evaluate and document knee range of motion. If very stiff, anticipate need for an extensile exposure.
Evaluate knee stability and ligament competence. If notably compromised, anticipate the need for more constrained implants, such as constrained condylar implants, or hinged implants.
Evaluate and document neurovascular status. If good pulses are not present, consider vascular noninvasive studies and transcutaneous oxygen testing, and if appropriate, vascular specialist consultation.
Evaluate extensor mechanism competence and tracking.
Perform hip examination to make sure there is no coexistent hip pathology that could refer pain to knee.

Figure 58.1 ▪ Patient with previous serious soft tissue injury and multiple previous infections about the knee. Preoperative evaluation and coordination with plastic surgery team is valuable.

Radiographs