Assessing the High-Risk Patient for Revision Total Knee Replacement

Orthopedists have the opportunity and obligation to ensure medical optimization prior to surgery. Doing so maximizes the likelihood of a successful reconstruction and minimizes the risk of complications. Inherently, revision surgery carries increased risks of both systemic and local complications as compared to primary arthroplasty, even in the ideal host. While “high-risk” in the specific context of revision total knee replacement has not been defined, two principals are helpful. First, medical comorbidities recognized as risk factors for systemic complications following primary total knee arthroplasty are equal, if not more important in the revision setting, where the operative duration tends to be longer. Second, bone stock damage, ligament deficiency or absence, vascular compromise, scarring, and prior skin incisions all increase the risk of local complications.