The painful knee after TKA: a diagnostic algorithm for failure analysis
- 6 August 2011
- journal article
- research article
- Published by Wiley in Knee Surgery, Sports Traumatology, Arthroscopy
- Vol. 19 (9), 1442-1452
- https://doi.org/10.1007/s00167-011-1634-6
Abstract
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.Keywords
This publication has 54 references indexed in Scilit:
- The Epidemiology of Revision Total Knee Arthroplasty in the United StatesClinical Orthopaedics and Related Research, 2010
- Prolonged Bacterial Culture to Identify Late Periprosthetic Joint Infection: A Promising StrategyClinical Infectious Diseases, 2008
- Comparison of the information in arthroplasty registers from different countriesThe Journal of Bone and Joint Surgery. British volume, 2008
- Complex regional pain syndrome with special emphasis on the kneeThe Journal of Bone and Joint Surgery. British volume, 2007
- Interleukin-6, procalcitonin and TNF-αThe Journal of Bone and Joint Surgery. British volume, 2007
- Early mechanical failure in total knee arthroplastyInternational Orthopaedics, 2006
- The Increasing Financial Burden of Knee Revision Surgery in the United StatesClinical Orthopaedics and Related Research, 2006
- Validity of an oblique posterior condylar radiographic view for revision total knee arthroplastyThe Journal of Bone and Joint Surgery. British volume, 2005
- Why knees failThe Journal of Arthroplasty, 2003
- Why Are Total Knee Arthroplasties Failing Today?Clinical Orthopaedics and Related Research, 2002