title: Causes of a painful total knee arthroplasty. Are patients still receiving total knee arthroplasty for extrinsic pathologies?
abstract: OBJECTIVE
  Whilst patients undergoing total knee replacements generally have good relief of their symptoms, up to 20% complain of persisting pain. Revision rates have therefore been rising, particularly so for unexplained pain. We reviewed the causes of painful total knee replacements including extrinsic causes.
  
  
  METHODS
  Forty-five consecutive patients referred to our department with painful total knee replacement were reviewed with our standard protocol, including history and examination, inflammatory markers and radiological studies including radiographs of the hip and knee and computed tomography scan of the knee joint.
  
  
  RESULTS
  Of the 45 patients, 15 patients had degenerative hip and lumbar spine disease which resolved after injections of the relevant joints. Nine patients had unexplained pain.
  
  
  CONCLUSIONS
  Patients may still be undergoing knee arthroplasty for degenerative lumbar spine and hip osteoarthritis. We suggest heightened awareness at pre- and post-operative assessment and thorough history and examination with the use of diagnostic injections to identify the cause of pain if there is doubt.
authors.affiliation: Department of Trauma and Orthopaedics, Lister General Hospital, Stevenage, UK. nawfal@yahoo.com
authors.forename: Nawfal
authors.initials: N
authors.lastname: Al-Hadithy
authors.forename: Hamoun
authors.initials: H
authors.lastname: Rozati
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Sewell
authors.forename: Alex L
authors.initials: AL
authors.lastname: Dodds
authors.forename: Peter
authors.initials: P
authors.lastname: Brooks
authors.forename: Minhal
authors.initials: M
authors.lastname: Chatoo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D007718:Knee Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D007719:Knee Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D010146:Pain / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology