The management of patients with painful total knee replacement

• Published in: Journal of bone and joint surgery. British volume Vol. 91; no. 2; pp. 143 - 150
• Main Authors: TOMS, A. D, MANDALIA, V, HAIGH, R, HOPWOOD, B
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.02.2009; British Editorial Society of Bone & Joint Surgery
• Edition: British volume
• Subjects: Analgesics - therapeutic use; Arthralgia - etiology; Arthralgia - therapy; Arthroplasty, Replacement, Knee - adverse effects; Biological and medical sciences; Complex Regional Pain Syndromes - therapy; Diseases of the osteoarticular system; Female; Fractures, Bone - etiology; Fractures, Bone - therapy; Humans; Joint Instability - etiology; Joint Instability - therapy; Knee Joint; Male; Medical sciences; Neuralgia - therapy; Neuromuscular Diseases - therapy; Orthopedic surgery; Pain, Postoperative - etiology; Pain, Postoperative - therapy; Patella - injuries; Prosthesis Failure; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - therapy; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Human; Total knee arthroplasty; Orthopedic surgery; Pain; Treatment
• ISSN: 0301-620X; 2049-4394; 2044-5377; 2049-4408
• DOI: 10.1302/0301-620X.91B2.20995

The management of patients with a painful total knee replacement requires careful assessment and a stepwise approach in order to diagnose the underlying pathology accurately. The management should include a multidisciplinary approach to the patient's pain as well as addressing the underlying aetiology. Pain should be treated with appropriate analgesia, according to the analgesic ladder of the World Health Organisation. Special measures should be taken to identify and to treat any neuropathic pain. There are a number of intrinsic and extrinsic causes of a painful knee replacement which should be identified and treated early. Patients with unexplained pain and without any recognised pathology should be treated conservatively since they may improve over a period of time and rarely do so after a revision operation.