title: The management of patients with painful total knee replacement.
abstract: The management of patients with a painful total knee replacement requires careful assessment and a stepwise approach in order to diagnose the underlying pathology accurately. The management should include a multidisciplinary approach to the patient's pain as well as addressing the underlying aetiology. Pain should be treated with appropriate analgesia, according to the analgesic ladder of the World Health Organisation. Special measures should be taken to identify and to treat any neuropathic pain. There are a number of intrinsic and extrinsic causes of a painful knee replacement which should be identified and treated early. Patients with unexplained pain and without any recognised pathology should be treated conservatively since they may improve over a period of time and rarely do so after a revision operation.
authors.affiliation: Exeter Knee Reconstruction Unit, Royal Devon & Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK. andrew.toms@rdeft.nhs.uk
authors.forename: A D
authors.initials: AD
authors.lastname: Toms
authors.forename: V
authors.initials: V
authors.lastname: Mandalia
authors.forename: R
authors.initials: R
authors.lastname: Haigh
authors.forename: B
authors.initials: B
authors.lastname: Hopwood
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D018771:Arthralgia / Q000209:etiology / Q000628:therapy*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D020918:Complex Regional Pain Syndromes / Q000628:therapy; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000628:therapy; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000628:therapy; D007719:Knee Joint; D008297:Male; D009437:Neuralgia / Q000628:therapy; D009468:Neuromuscular Diseases / Q000628:therapy; D010149:Postoperative Pain / Q000209:etiology / Q000628:therapy*; D010329:Patella / Q000293:injuries; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000628:therapy
chemical_list: D000700:Analgesics