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Evaluation of the Painful Total Knee Arthroplasty

Flierl, Michael A. MD; Sobh, Ali H. MD; Culp, Brian M. MD; Baker, Erin A. PhD; Sporer, Scott M. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: October 15, 2019 - Volume 27 - Issue 20 - p 743-751
doi: 10.5435/JAAOS-D-18-00083
Review Article
SDC

Total knee arthroplasty (TKA) has been associated with notable improvements in health-related quality of life of patients with end-stage knee arthritis. Although most patients experience substantial symptomatic relief after TKA, up to 19% of patients are unsatisfied with their outcome. With the dramatic, projected increase in the number of TKAs performed annually, it is crucial to appreciate the various modes of failure associated with this procedure. A comprehensive understanding of the symptomatology and thorough clinical examination aid in identifying the etiology of ongoing knee pain. Ancillary testing including conventional laboratory analyses, imaging studies, and diagnostic injections supplement a thorough history and physical examination. In addition, novel laboratory markers, RNA/DNA-based tests, and novel imaging modalities are emerging as beneficial tools in evaluating patients with a painful TKA. A well-structured, algorithmic approach in the management of these patients is essential in correctly diagnosing the patient and optimizing clinical outcomes.

From the Beaumont Health, Departments of Orthopaedic Surgery and Research, Royal Oak, MI (Dr. Flierl, Dr. Sobh, and Dr. Baker), the Princeton HealthCare System, Department of Orthopaedic Surgery, Princeton, NJ (Dr. Culp), and the Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, IL (Dr. Sporer).

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Flierl, Dr. Sobh, Dr. Culp, Dr. Baker, and Dr. Sporer.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.jaaos.org).

Copyright 2019 by the American Academy of Orthopaedic Surgeons.
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