Consensus on Reducing Risk in Total Joint Arthroplasty: Revision Surgery

Rates of revision hip and knee arthroplasty continue to increase. Patients undergoing revision hip and knee arthroplasty face a different set of challenges than those undergoing primary arthroplasties, with increased rates of medical and surgical complications. Specifically, patients undergoing revision arthroplasty have higher rates transfusion, more unplanned readmissions, greater cardiac and renal complications, and more frequent surgical complications including surgical site infections and need for reoperation and revision surgery. Multiple strategies may be used in an effort to lower these risks, including shifting these surgeries to higher volume medical centers and surgeons, vigorously optimizing revision arthroplasty patients in the preoperative setting, using blood conserving strategies including universal use of tranexamic acid and selective use of blood cell salvage and reinfusion, and closed-incision negative wound pressure therapy to decrease rates of wound complications and surgical site infections.