Systematic analysis of painful total knee prosthesis, a diagnostic algorithm

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Pain Management

Background:

• Persistent pain affects approximately 20% of patients post-total knee arthroplasty (TKA).
• A significant portion (60%) of these painful knees require revision surgery within five years.
• Unexplained TKA pain presents a diagnostic challenge despite available clinical and radiographic methods.

Purpose of the Study:

• To present a systematic 10-step diagnostic algorithm for evaluating patients with persistent painful TKA.
• To guide surgeons in identifying the underlying etiology of unexplained TKA pain.
• To discuss preliminary results from a series of 100 consecutive cases.

Main Methods:

• Review of extrinsic and intrinsic causes of painful TKA.
• Development of a structured diagnostic pathway.
• Analysis of preliminary data from 100 consecutive TKA cases.

Main Results:

• Diagnosis of unexplained painful TKA often exceeds 12 months, leading to patient dissatisfaction and psychological distress.
• A multidisciplinary approach is crucial for managing patient pain and addressing etiology.
• Revision surgery was reserved for cases with a clear failure mechanism.

Conclusions:

• A systematic diagnostic algorithm can improve the evaluation of painful TKA.
• Timely diagnosis and appropriate management are essential to prevent patient dissatisfaction and psychological issues.
• Identifying a clear failure mechanism is key for determining the need for revision surgery.