Abstract
There are a substantial number of patients who continue to complain of pain following
total knee arthroplasty (TKA). There are many potential causes of continued pain,
and these are broadly categorized into intrinsic and extrinsic sources. When evaluating
a patient with a painful TKA, the physician begins with a thorough history and physical
examination, along with the appropriate radiographs. Further workup includes laboratory
analysis, specifically evaluating the inflammatory markers erythrocyte sedimentation
rate and C-reactive protein, along with a synovial fluid aspirate evaluating the white
blood cell count with differential and culture. Advanced imaging modalities are sometimes
helpful when the diagnosis remains unclear, including stress radiographs, live fluoroscopic
imaging, ultrasound, nuclear imaging, and magnetic resonance imaging. Further surgery
is not advisable without a clear diagnosis, as this is associated with very poor results.
Instead, serial follow-up or a referral to a specialist for a second opinion may be
most appropriate.
Keywords
knee pain - total knee arthroplasty - failure
