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

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.