Removal of the Femoral and Tibial Components for Revision Total Knee Arthroplasty

The importance of implant removal in revision knee arthroplasty frequently is overlooked as the surgeon concentrates on the planned reconstructive phase of the operation (Berry, Revision total knee arthroplasty. Lippincott-Raven, Philadelphia, pp 187–196, 1999). However, safe and effective implant removal is important for several reasons. First, implant removal can be a time-consuming process, particularly if the surgeon is not familiar with optimal techniques or if the surgeon does not have optimal tools available for the purpose. Second, severe bone loss or bone fracture can occur during implant removal. Marked unnecessary bone loss has a substantial negative impact on the type and quality of the reconstruction that subsequently can be performed. Third, struggle with exposure and implant removal can lead to soft tissue injury that compromises collateral ligament attachments or the extensor mechanism. Methods of safe implant removal have advanced dramatically over the last decade, and in most cases today, implants can be removed efficiently and with relatively little bone loss.