The Multiply Revised Knee: Techniques for What to Do Next.

The multiply revised total knee arthroplasty (TKA) poses unique surgical challenges. Patients who present to the office with a failed TKA or revision TKA expect durable, long-term fixation and improved function, yet bone loss and extensor mechanism insufficiency can easily complicate the reconstruction. The aim of this American Association of Hip and Knee Surgeons symposium was to provide up-to-date guidance for rerevision TKA with a specific focus on (1) safe exposure; (2) improved fixation with impaction grafting; (3) improved fixation using porous metal structural augmentation; and (4) managing the patella. After reviewing this article, the reader should feel comfortable with standard and extensile exposures of a revision knee arthroplasty, understand the technique and outcomes for impaction bone grafting and the use of porous metal augmentation, and develop an algorithm for treating and optimizing patello-femoral kinematics through augmentation and reconstruction techniques.