revision TKR

Question 1

What are your concerns for a primary revision for asceptic loosening?

Answer 1

• collateral dysfunction
• state of extensor mechanism
• bone loss
  -need for constraint TKR

Question 2

what are the options for maximising exposure for a revision TKR?

Answer 2

• rectus snip - no difference in outcomes compared to the medial parapatellar approach
• tibial tubercle osteotomy - good for patella Baja, but risk of non-union

Question 3

how can you classify bone loss in revision TKR?

Answer 3

1. Minor metaphyseal defect
2. Metaphyseal injury affecting the femoral condyle/ tibial plateau
3. Massive bone loss - can involve collateral ligaments/ patella tendon

Question 4

what are the options for dealing with bone loss in revision TKR?

Answer 4

Defect <1cm
1. Cement - structurally better than allograft

Defect > 1cm
2. Metaphyseal sleeve
3. Trabecular metal cone
4. Structural allograft