Most problems encountered in difficult revision total knee arthroplasty can be managed by the wide range of systems now available. Modular metaphyseal sleeves or trabecular metal augments will provide stability even with significant bone loss, and hinged systems substitute for ligamentous deficiencies. Catastrophic failure that precludes reconstruction can be encountered. The alternative to arthroplasty in such drastic situations is knee arthrodesis, resection arthroplasty, and amputation. The relative indications for selection of alternatives are recurrent deep infection, immunocompromised patient, and extensive nonreconstructible hard- or soft-tissue loss. Techniques for each alternative will be reviewed.
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