Towards an understanding of the painful total knee: what is the role of patient biology?
Total knee arthroplasty (TKA) remains the treatment of choice for end-stage osteoarthritis of the knee. With an aging population, the demand for TKA continues to increase, placing a significant burden on a health care system that must function with limited resources. Although generally accepted as a successful procedure, 15-30 % of patients report persistent pain following TKA. Classically, pain generators have been divided into intra-articular and extra-articular causes. However, there remains a significant subset of patients for whom pain remains unexplained. Recent studies have questioned the role of biology (inflammation) in the persistence of pain following TKA. This article aims to serve as a review of previously identified causes of knee pain following TKA, as well as to explore the potential role of biology as a predictor of pain following knee replacement surgery.
Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada.
Stephen
S
Preston
Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada.
Massimo
M
Petrera
Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada.
Christopher
C
Kim
Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada.
Michael G
MG
Zywiel
Division of Orthopaedic Surgery, Arthritis Program, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada.|Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst St, Room 1E439, Toronto, Ontario M5T 2S8 Canada.
Rajiv
R
Gandhi
Arthroplasty; Biology; Inflammation; Knee; Pain; Painful