Our experience with revision arthroplasty of the knee is more limited than with the hip because there is a 4:1 ratio of total hip to knee total joint replacements in North America. Loss of bone stock is the main problem with knee revision surgery although less than that associated with the hip. The options for salvage are to use more cement, a custom prosthesis or autograft. An arthrodesis is difficult at the best of times and generally unacceptable in North America today. Excision arthroplasty is not as good in the knee as the hip although, like an amputation, it is an option. Reconstruction with cement is weak and may lead to more rapid bone loss. Metal wedges are probably too small for most revisions so we tend to use bone grafts which give better load transfer.
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