Getting out the well-fixed knee: All hands on deck

摘要

A well-fixed total knee arthroplasty can be removed using a systematic, stepwise approach. After establishing a preoperative diagnosis and ensuring that appropriate extraction instrumentation is available, the components of a successful explantation include appropriate superficial and deep exposure, protection of the extensor mechanism, a mobile surgical window, and careful, thorough disruption of the bone-implant or cement-implant interface. To facilitate explantation, the tibial insert, femoral implants, and tibial implants should be removed in sequence while minimizing forceful extraction to preserve bone stock. Keys to a successful reconstruction include augmenting or restoring bone loss, maintaining the joint line, balancing flexion and extension gaps, maintaining appropriate femoral rotation, and utilizing the appropriate level of implant constraint.