title: [Painful total knee arthroplasty. A treatment algorithm].
abstract: BACKGROUND
  Persisting and newly occurring complaints after implantation of a total knee endoprosthesis (TKE) are common problems for orthopaedic surgeons in clinics and private practices. The search for the cause and the diagnostics are often difficult due to the many possible influencing factors. Painful TKE requires patience from the orthopaedic surgeon as well as from the patient.
  The indications for surgical revision should basically be considered with caution and conservative therapeutic procedures can contribute to a considerable improvement in complaints. The treatment algorithm presented in this article helps to adopt a therapeutic direction and if necessary in assessing the indications for revision or replacement surgery. The algorithm offers the possibility of a systematic classification according to clinical, radiological and laboratory testing aspects and assists in the decision for further procedures depending on the four differential diagnoses of limitations in movement, instability, loosening and infection.
  
  
  CONCLUSIONS
  Revision operations should be performed in specialized centers and should be tailored to the individual patient. A comprehensive knowledge of knee joint biomechanics and experience with the large spectrum of modular and axis-linked revision systems are essential for revision surgeons.
authors.affiliation: Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland, m.woerner@asklepios.com.
authors.forename: M
authors.initials: M
authors.lastname: Wörner
authors.forename: H R
authors.initials: HR
authors.lastname: Springorum
authors.forename: B
authors.initials: B
authors.lastname: Craiovan
authors.forename: S
authors.initials: S
authors.lastname: Winkler
authors.forename: J
authors.initials: J
authors.lastname: Grifka
authors.forename: T
authors.initials: T
authors.lastname: Renkawitz
mesh_terms: D000465:Algorithms; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods; D003937:Diagnosis, Differential; D006801:Humans; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D012086:Reoperation / Q000379:methods