Revision total knee arthroplasty presents a unique set of problems when attempting to balance flexion and extension gaps. Loss of soft tissue support and established deformity can make balancing difficult. One needs to balance the flexion and extension gap heights as well as medial and lateral symmetry, which may not always be attainable. We used a set of stepwise techniques to reestablish the joint line in extension using femoral augments, and then balanced the flexion gap using different sized femoral components. We retrospectively analyzed 45 patients who had revision total knee replacement with an average of 4 years followup. These patients had a mean flexion of 105° and none had signs of instability in flexion or extension or on clinical exam. Despite the complex nature of revision knee arthroplasty, cases utilizing an algorithm to balance the extension and flexion gaps, with increased implant constraint when necessary, can aid in obtaining a good outcome.
Level of Evidence: Therapeutic study, level IV (case series). See Guidelines for Authors for a complete description of levels of evidence.