title: Evaluation of the painful total knee arthroplasty.
abstract: There are a substantial number of patients who continue to complain of pain following total knee arthroplasty (TKA). There are many potential causes of continued pain, and these are broadly categorized into intrinsic and extrinsic sources. When evaluating a patient with a painful TKA, the physician begins with a thorough history and physical examination, along with the appropriate radiographs. Further workup includes laboratory analysis, specifically evaluating the inflammatory markers erythrocyte sedimentation rate and C-reactive protein, along with a synovial fluid aspirate evaluating the white blood cell count with differential and culture. Advanced imaging modalities are sometimes helpful when the diagnosis remains unclear, including stress radiographs, live fluoroscopic imaging, ultrasound, nuclear imaging, and magnetic resonance imaging. Further surgery is not advisable without a clear diagnosis, as this is associated with very poor results. Instead, serial follow-up or a referral to a specialist for a second opinion may be most appropriate.
authors.affiliation: Division of Adult Reconstruction, The CORE Institute, Center for Orthopaedic Research and Education, Phoenix, Arizona.
authors.forename: Robert
authors.initials: R
authors.lastname: Cercek
authors.affiliation: Division of Adult Reconstruction, The CORE Institute, Center for Orthopaedic Research and Education, Phoenix, Arizona.
authors.forename: Richard
authors.initials: R
authors.lastname: Bassett
authors.affiliation: Division of Adult Reconstruction, The CORE Institute, Center for Orthopaedic Research and Education, Phoenix, Arizona.
authors.forename: Steve
authors.initials: S
authors.lastname: Myerthall
mesh_terms: D018771:Arthralgia / Q000209:etiology*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D010149:Postoperative Pain / Q000209:etiology*; D011475:Prosthesis Failure; D012086:Reoperation