A stepwise approach to revision total knee arthroplasty

Successful revision total knee arthroplasty requires detailed preoperative planning and then a meticulous, stepwise execution of the predetermined plan. Critical factors in revision total knee arthroplasty include the choice of skin incision, type of surgical approach, and component removal without removal of substantial additional bone. The surgeon must then assess the degree of bone loss and ligamentous stability and the position of the current joint line, and then determine the type of bone graft, prosthetic components, and fixation methods required to correct the intraoperative deficiencies. Accurate restoration of flexion-extension gap balance is imperative to ensure long-term successful results.