The painful knee after TKA: a diagnostic algorithm for failure analysis

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 19; no. 9; pp. 1442 - 1452
• Main Authors: Hofmann, S., Seitlinger, G., Djahani, O., Pietsch, M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.09.2011; Springer Nature B.V
• Subjects: Aged; Algorithms; Analysis; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - methods; Chronic Disease; Chronic pain; Equipment Failure Analysis - methods; Evaluation; Failure; Failure analysis; Female; Follow-Up Studies; Hospitals; Humans; Infections; Joint replacement surgery; Knee; Knee Prosthesis; Knees; Male; Medicine; Medicine & Public Health; Middle Aged; Observation; Orthopedics; Osteoarthritis, Knee - diagnostic imaging; Osteoarthritis, Knee - surgery; Pain; Pain Management; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - surgery; Patients; Postoperative Complications - diagnosis; Postoperative Complications - surgery; Prosthesis Failure; Radiography; Reoperation - methods; Risk Assessment; Scintigraphy; Skill analysis; Surgeons; Surgery; Tomography; Treatment Outcome; Ultrasonic imaging; X-rays; Austria; Total knee arthroplasty; Pain; Diagnostic algorithm; Imaging; Failure
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-011-1634-6

Pain after total knee arthroplasty (TKA) represents a common observation in about 20% of the patients after surgery. Some of these painful knees require early revision surgery within 5 years. Obvious causes of failure might be identified with clinical examinations and standard radiographs only, whereas the unexplained painful TKA still remains a challenge for the surgeon. It is generally accepted that a clear understanding of the failure mechanism in each case is required prior considering revision surgery. A practical 10-step diagnostic algorithm is described for failure analysis in more detail. The evaluation of a painful TKA includes an extended history, analysis of the type of pain, psychological exploration, thorough clinical examination including spine, hip and ankle, laboratory tests, joint aspiration and test infiltration, radiographic analysis and special imaging techniques. It is also important to enquire about the length and type of conservative therapy. Using this diagnostic algorithm, a sufficient failure analysis is possible in almost all patients with painful TKA. Level of evidence IV.