Bone Loss in Revision Total Knee Arthroplasty

Revision total knee arthroplasty presents several complex challenges for the reconstruction surgeon, including management of bone loss, ligamentous insufficiency, level of constraint and difficulty in achieving lasting fixation. Bone loss in revision total knee arthroplasty may occur as a result of the original disease, the original implant design, technical surgical error at implantation, explantation or the mechanism of failure, e.g. aseptic loosening, infection and polyethylene granuloma. Revision surgery should relieve pain and improve function whilst addressing the reason for failure. Methods of reconstruction include the use of cement; modular metal augmentation of prostheses; custom-made, tumour-type or hinged implants; and bone grafting.