Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 4, pp 1011–1017 | Cite as

Revision knee complexity classification—RKCC: a common-sense guide for surgeons to support regional clinical networking in revision knee surgery

  • J. R. A. PhillipsEmail author
  • L. Al-Mouazzen
  • R. Morgan-Jones
  • J. R. Murray
  • A. J. Porteous
  • A. D. Toms



There is considerable variation in practice throughout Europe in both the services provided and in the outcomes of Revision Knee Surgery. In the UK, a recent report published called get it right first time (GIRFT) aims to improve patient outcomes through providing high quality, cost-effective care, and reducing complications. This has led to the development of a classification system that attempts to classify the complexity of revision knee surgery, aiming to encourage and support regional clinical networking.


The revision knee classification system (RKCC) incorporates not only complexity, but also patient factors, the presence of infection, the integrity of the extensor mechanism, and the soft tissues. It then provides guidance for clinical network discussion. Reliability and reproducibility testing have been performed to establish the inter- and intra-observer variabilities using this classification.


Good correlation between first attempt non-expert and experts, good intra-observer variability of non-expert, and an excellent correlation between second attempt non-expert and experts has been achieved. This supports the use of RKCC by both inexperienced and experienced surgeons.


The revision knee complexity classification has been proposed that offers a common-sense approach to recognize the increasing complexity in revision TKR cases. It provides a methodological assessment of revision knee cases and support regional clinical networking and triage of appropriate cases to revision units or specialist centres.

Level of Evidence

Expert opinion, Level V.



No funding received.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic CentreRoyal Devon and Exeter HospitalExeterUK
  2. 2.University Hospital LlandoughCardiffUK
  3. 3.Southmead HospitalBristolUK

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