SummaryContemporary treatment of fractures of the distal femur, proximal tibia, and patella involves the use of internal fixation. Although most fractures heal uneventfully, failures of internal fixation about the knee do occur. Factors that contribute to failure include large physiologic forces, concomitant ligamentous injuries, limb malalignment, joint malorientation, bone stock deficiency, arthrofibrosis, patella infera, infection, avascular necrosis, and technical errors. Understanding these factors is necessary for successful revision surgery. This paper reviews the factors that contribute to the failure of internal fixation of fractures about the knee joint (distal femur fractures, tibia fractures, and patella fractures) and presents practical techniques of revision surgery.