loss, choice of implant and level of constraint. During clinical examination, the surgeon must evaluate skin temperature, redness, swelling, deformity both at rest and during weight-bearing, peripheral pulses, range of motion (particularly stiffness 4
Francesco Benazzo, Stefano M.P. Rossi, Alberto Combi, Sanjay Meena, and Matteo Ghiara
Jun Zhang, Erhu Li, and Yuan Zhang
evidence-based guidelines. In particular, it presents specific decision aids regarding unclear issues such as the optimal level of constraints, individualized design, length, fixation of extension stems, and the pros and cons of modularity. We conducted a
Thomas Tampere, Matthieu Ollivier, Christophe Jacquet, Maxime Fabre-Aubrespy, and Sébastien Parratte
revision or as in segmental TKA reconstruction for tumour. Implant type and level of constraint are related to the type and the level of the fracture and the degree of metaphyseal destruction. The goal of surgery is to provide a stable, mobile knee allowing
Emmanuel Thienpont
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Revision total knee arthroplasty (rTKA) is a challenging, complex procedure. A comprehensive understanding of the anatomy, challenges and pitfalls is essential to achieve a good outcome for the patient.
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This review discusses the determinants of good outcomes of rTKA. These include, among other factors, the choice of the surgical approach, removal of the components, adequate reconstruction of the joint line and posterior condylar offset and the use of offset stems, as well as choosing the appropriate level of constraint.
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The modularity of many modern knee revision systems can help to address such issues as anatomical mismatch, gap balancing and malalignment.
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A well-planned surgical approach must be used in rTKA. A thorough understanding of related knee anatomy is essential.
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The incidence of joint-line elevation after rTKA is high. Contralateral radiographs, as well as algorithms based on the relationship between bony landmarks and the joint line, can help to reconstruct a physiological joint line during rTKA.
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Modularity added to systems, such as offset stems, are useful enhancements that may further improve the reconstruction of the anatomy.
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There are several options for managing the patella, with the best choice depending on the status of the patellar component and residual bone stock.
Cite this article: Thienpont E. Revision knee surgery techniques. EFORT Open Rev 2016;1: 233-238. DOI: 10.1302/2058-5241.1.000024.
Gilles Pasquier, Matthieu Ehlinger, and Didier Mainard
levels of constraint Constraints A constrained implant is necessary when the soft tissues fail (ligaments, capsular elements and muscles) or when the bone structure is insufficient to support the load or ligament tension. A constrained prosthesis is
Francesco Benazzo, Loris Perticarini, Eugenio Jannelli, Alessandro Ivone, Matteo Ghiara, and Stefano Marco Paolo Rossi
Introduction The variability in the decision about whether to resurface the patella in total knee replacement (TKR) is influenced by different factors including geographic location, training of surgeons, implant design and level of constraint
Daniel Bachman and Akin Cil
completely constrained. With high levels of constraint there was a high prevalence of aseptic loosening due to increased forces transmitted to the prosthesis-cement interface. Current designs are described as a semi-constrained “sloppy” hinge, allowing for
Piti Rattanaprichavej, Patapong Towiwat, Artit Laoruengthana, Piyameth Dilokthornsakul, and Nathorn Chaiyakunapruk
been described by a single contemporary study, which would impair the ability to interpret with respect to this issue. 1 The ideal prosthesis for CNA, in terms of level of constraint, is still debated. Poor bone quality and gross instability due
Geert Meermans, George Grammatopoulos, Moritz Innmann, and David Beverland
target is a topic of further study. Patient positioning It has been shown that the surgeons position the patients differently at the time of set-up for a THA and different pelvic supports provide varying levels of constraint to movement during
Ahmed Siddiqi, Timothy Horan, Robert M. Molloy, Michael R. Bloomfield, Preetesh D. Patel, and Nicolas S. Piuzzi
different level of constraint and haptic feedback, and designs are classified as either passive, active or semi-active systems. Passive modalities are under direct and continuous surgeon control. Contrarily, active robotic platforms perform a designated
