Revision Knee Arthroplasty: “Art” Through Science

Total knee arthroplasty (TKA) has proven to be an outstanding procedure in terms of alleviating pain and improving function in patients with advanced arthritis of the knee. However, based on the ubiquity of primary procedures due to demographic trends and its relatively low risks, there has been a steady subsequent rise in the volume of revision TKA procedures in the United States in recent years. Furthermore, recent estimates suggest the number of revision TKA procedures is expected to significantly increase over the next several decades. Projections also suggest that the need for revision knee arthroplasty in the future will produce an immense economic burden.

For the surgeon who performs primary knee replacement, there is often fear and anxiety around the rare patient who presents with pain after a seemingly successful primary arthroplasty procedure. This is especially true for those surgeons with limited experience in the revision arena. Although there is much written on the technique of revision arthroplasty, less is written about the actual evaluation, and diagnosis of, the painful total knee arthroplasty. This special focus section on revision total knee arthroplasty concentrates on exactly this topic, as well as covering the causes of failure based on registry data. Articles in this section include a review of diagnosing and managing instability after knee arthroplasty, an often under-recognized complication and cause of pain, as well as an article that highlights the modern prevention, diagnosis, and treatment of infection by Craig Della Valle et al. Robert Cercek et al explain how to evaluate a painful arthroplasty and include aspects traversing the spectrum from “the art” of medicine, such as history and physical exam techniques, through the science of advanced testing modalities. There is also a review of stiffness after total knee arthroplasty by Parvizi et al, and a review of failure modalities by Wael Barsoum and members of the Cleveland Clinic program.

I believe this special section in the Journal of Knee Surgery will provide a fantastic and concise knowledge base related to the diagnosis and management of the complications of knee arthroplasty and is ideally suited for physicians who are seeing an ever increasing number of arthritis patients. As patients continue to allow us the privilege to care for them and the ones that they love, we must embrace the responsibility of being able to manage the times when outcomes are less than desirable. I believe that this special section will help with this task. I sincerely hope that you find the same to be true.