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J Knee Surg 2015; 28(02): 113-118
DOI: 10.1055/s-0034-1396081
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evaluation of the Painful Total Knee Arthroplasty

Robert Cercek
1   Division of Adult Reconstruction, The CORE Institute, Center for Orthopaedic Research and Education, Phoenix, Arizona
,
Richard Bassett
1   Division of Adult Reconstruction, The CORE Institute, Center for Orthopaedic Research and Education, Phoenix, Arizona
,
Steve Myerthall
1   Division of Adult Reconstruction, The CORE Institute, Center for Orthopaedic Research and Education, Phoenix, Arizona
› Author Affiliations
Further Information

Publication History

21 September 2014

23 October 2014

Publication Date:
24 November 2014 (online)

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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
 

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