Preventing Complications in Complex Repeat Revision Total Knee Arthroplasty: Advanced Exposure, Implant Removal, and Handling the Extensor Mechanism.

Revision total knee arthroplasty (rTKA) is an increasingly common challenge for arthroplasty surgeons. The survivorship of rTKA is significantly lower than that of primary total knee arthroplasty, resulting in an increasing incidence of repeat rTKA. These cases present multifactorial challenges including the skin and soft-tissue envelopes, bone loss, ligamentous compromise, and often a history of periprosthetic joint infection. This is compounded by difficult exposure, iatrogenic trauma from additional surgery, and often challenging implant removal. Here, strategies to prevent perioperative repeat rTKA complications are discussed by highlighting key components of preoperative planning and techniques for advanced exposure, implant removal, and extensor mechanism reconstruction.