TKA revision for loosening

This is a 73 year old female who previously had liver transplantation due to autoimmune hepatitis. She had knee replacement at another institution 15 years ago with a good initial result. She developed worsening pain over the past year and was found to have severe loosening of the tibial component with massive bone loss and a large tibial defect. She was told she would never walk again and that she was too high risk for revision surgery.

The patient was medically optimized with the assistance of Mount Sinai liver specialists. While a high risk case, Dr. Chen believed that the benefits outweighed the risks of surgery and proceeded. She underwent successful, uncomplicated revision TKA. A constrained condylar knee prosthesis was used with long hybrid fixation stems. A large, highly porous tantalum cone and augment were used to reconstruct the massive tibial bone defect.

The patient is able to walk with a cane and has maintained her ambulatory status. She has no pain and excellent range of motion.