(iv) Managing bone loss of the femur and tibia in revision total knee arthroplasty

Total knee arthroplasty is a common and highly effective procedure. However, approximately 5% of arthroplasties can be expected to have failed within 10 years of implantation, and the number of revision arthroplasties required continues to rise in parallel to the trend for increasing numbers of primary procedures. Revision knee arthroplasty is a technically challenging procedure, with one of the most difficult issues that is frequently encountered being loss of bone. Accurately identifying and characterizing bone loss prior to revision, avoiding bone loss at the time of explantation of protheses, and careful advanced planning for appropriate equipment and graft materials to be available at the time of revision surgery are all essential prerequisites for a successful outcome after revision knee arthroplasty. This article summarizes the types of bone loss that can be seen, the appropriate methods for their identification and suggests strategies for how best to address bone loss at the time of revision surgery, to ensure the best possible short- and long-term outcomes.