History and Physical Examination for the Painful Total Knee Arthroplasty

Algorithm

The algorithm presents a flow chart of temporal events and suggested etiology.

Introduction

Total knee arthroplasty (TKA) is a successful and durable procedure for management of the painful arthritic knee. The literature demonstrates more than 90% survivorship at 20 years with a well-performed arthroplasty. As the number of annual primary TKAs performed each year increases exponentially, the number of revision TKAs also continues to grow despite improvements in implant design, biomaterials, and techniques. The increase in the revision TKA burden is especially seen within high-volume and tertiary referral arthroplasty centers. The modes of failure are variable, are influenced by a multitude of factors, and can result from instability, infection, component loosening or malposition, stiffness, periprosthetic fracture, component breakage, polyethylene wear, or osteolysis. When failure does occur and revision is contemplated, a very thorough history and physical examination, along with imaging studies and laboratory tests, are necessary. It is imperative that the preoperative evaluation identify the cause of failure to increase the likelihood of successful revision TKA. This chapter focuses on the history and physical examination of patients with painful TKA. Imaging of the painful TKA is covered in Chapter 4 and the laboratory tests in Chapter 3 .

Patient History