Total knee replacements (TKRs) are supposed to provide pain relief and improve function for patients with knee arthritis. In about five percent of the cases, this doesn't happen. The patient still has pain after TKR. In this report surgeons help other surgeons figure out what's wrong with each patient and how to treat them.
The first step is to take a history and conduct a careful physical exam. The problem could be coming from somewhere else like the hip or back. Imaging studies and lab tests may help identify infection or fracture. The authors review each of these diagnostic tools and their uses in detail.
Understanding pain patterns can help sort out pain from soft-tissue, implant loosening, or loss of blood supply. Assessing joint stability can give the doctor clues about possible intra-articular (inside the joint) causes of pain, stiffness, or swelling.
The physician must consider other health or mental problems as well. Depression, diabetes, and heart disease are just a few conditions that may be adding to the problem. The patient's medications may give the doctor an idea of other health conditions present.
The authors say that patients with post-TKR pain should not have revision surgery to find out what's wrong. The problem should be identified first before treatment is applied. A step-by-step evaluation as described is essential.
Edward C. Brown III, MD, et al: The Painful Total Knee Arthroplasty: Diagnosis and Management. In Orthopedics. February 2006. Vol. 29. No. 2. Pp. 129-136.'