Revision TKA

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Lateral view of knee showing Total knee replacement. What concerns me is the loosening of the components with widespread radiolucency and bone loss around the tibial component. This is highly suggestive of infection
I will take a history to establish the cause and functional status of the patient. I will examine and investigate her to know the
- State of soft tissue and vascular status: Wound compli
- State of ligaments: Constrained prosthesis
- Bone loss: BG, Augmentation and stemmed implant

Type 1: intact metaphysic with minor defects (no effect on stability)
Type 2: Damaged metaphysis( cement augments/BG: Morcellasied/structural)
Type 3: Deficient Metaphysis ( Modular augments +/-Custom made hinged prosthesis with BG)

I can see an AP and lateral view of left knee of a 70 year old person with a TKR. What concerns me is the fracture of the supracondylar femur. I would like to know the mechanism and the time since the injury.
I will ensure that the injury is not limb threatening, it is isolated closed and the limb is neurovascularly intact.
I would like to see the entire length X-ray of femur and tibia to rule out any other fracture or implant in situ and give adequate analgesia and immobilise in a back slab
I will take further detailed history regarding indication for initial surgery, course after the procedure, history of any leaking wound and wound healing problem, ambulatory and cognitive status of the patient. I will try to know which implant was used.
I will discuss the patient’s problem with a senior knee specialist
I will also assess whether
- the implant is radiologically loose or stable,
- is the fracture very low metaphysial, or
- is there any comminution medially and
- try to review previous films.
I will rule out infection
Plan for revision vs fixation (use midline incision)