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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

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Notes

  1. Figures 1, 2, 3, 4, 5, 6, 7 and 8 show a representative case with painful TKA: 49 year old active police men, distal tibia fracture in 1980, scope 03/2008, primary TKA (mobile rotating platform) in 05/2009 for posttraumatic OA, post operative ROM 0-0-120° but disturbed gait, instability, recurrent effusion, pain during stair climbing and raising a chair, progression of pain. In 05/2010 isolated femur component revision for femur malrotation; post operative further progression of symptoms with limited flexion and walking distance. Referred to our institution, infection excluded, secondary depression, lost his job, massive disturbed gait, 50% quadriceps atrophy, multiple knee trigger points, but no signs for CRPS, limited flexion 0–0–80° with pain at max flexion, typical lateral flexion gap instability but no patella maltracking or anterior-posterior instability. In 01/2011 complete revision using a standard revision system and fix bearing PS with correction of femur malrotation, restoring posterior offset and lowering joint line. At 3 months post operative outcome is good with flexion 0–0–120°, stable knee, little swelling, normal gait and residual pain only, still working on muscular atrophy and not yet able to go back in his job.

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Hofmann, S., Seitlinger, G., Djahani, O. et al. The painful knee after TKA: a diagnostic algorithm for failure analysis. Knee Surg Sports Traumatol Arthrosc 19, 1442–1452 (2011). https://doi.org/10.1007/s00167-011-1634-6

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