Bone reconstruction in revision total knee arthrosplasty

There are approximately 20,000-revision total knee arthoplasties (TKA) performed in North America annually. With a growing number of TKAs being performed and the trend toward a longer life expectancy, failure of the primary TKA is inevitable, thus, revision TKAs are going to be performed at an increasing rate for years to come. A major issue in revision TKA is the degree of bone loss that has occurred. In this article the authors discuss the different classification schemes regarding bone loss and their impact on subsequent treatment modalities. A discussion on assessment of bone loss and the multiple techniques, along with indications for each, that can be employed intraoperatively to account for the bone loss will enable the surgeon to undergo the challenge of bone reconstruction in a stepwise fashion. The article provides advantages and disadvantages to each technique as well as a review of the current literature. Bone deficiency from component removal, osteolysis, or gap balancing can prove to be a significant problem in revision TKA. With careful planning, appropriate judgment, and good surgical technique, good results can be achieved.