[Revision analysis and successful solutions for my failed primary total knee arthroplasties].

Abstract

Background: The treatment of patients following primary total knee arthroplasty requiring revision surgery is one of the most demanding tasks in orthopedic surgery. A careful failure analysis and a systematic approach are of great importance for the often very individual situations. In addition to excellent technical skills, preoperative planning is of great importance.

Question: This paper describes the preoperative assessment and planning, as well as the technical strategy for the revision of primary knee arthroplasties.

Material and methods: Beside a review of the existing literature, the article introduces the senior author's revision strategies based on 20 years of experience in total joint replacement.

Results: Adequate preoperative imaging, laboratory tests and, if necessary, joint aspiration are essential for the individual diagnostics and planning of the revision procedure. The article focuses on the prophylaxis and treatment options for acute and chronic periprosthetic joint infections, aseptic implant loosening, arthrofibrosis and joint instability.

Discussion: It is often a challenge for the surgeon to face his/her own patient requiring a revision surgery, and the patient expects the same result for these technical, often much more demanding operations as for the primary surgery. This inherent conflict results in considerable challenges for the arthroplasty surgeon.