Abstract
The success of primary total knee arthroplasty is well-documented in literature with survival rates of over 90% at 15-year follow up. Unfortunately, some are not successful and require an eventual revision.
Recent projects indicate the burden of revision total knee arthroplasty is expected to increase. The majority of patients are subjectively satisfied with their revision knee arthroplasty, but many of them have unrealistic expectations regarding the longevity and function of their revision procedure.
We haven’t enough literature on tactics in cases of revision failure. The tactics, methods of treatment and results depend on the revision diagnosis.
The main indications of a first revision are aseptic loosening and instability. The infection is in fourth place.
But in the cases where failure required a second revision the main indications are changing. The major problem is instability, but the incidence of infection is the same.
We prefer two-stage exchange for repeated failure of TKA.We prefer ready-made spacers, because they can help to solve our problem of bone deficiency. We needn’t be afraid to use spacers in cases of MRSA infection.
In cases of doubt about the success of the revision it is better to choose a salvage procedure, because functional arthrodesis is better for the patient then an unsuccessful attempt.