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[The Berlin diagnostic algorithm for painful knee TKA].

K Thiele1, J Fussi2, C Perka2

  • 1Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Deutschland. Kathi.Thiele@charite.de.

Der Orthopade
|December 19, 2015
PubMed
Summary
This summary is machine-generated.

A reproducible algorithm helps analyze painful total knee arthroplasty (TKA) outcomes. This approach aids in diagnosing causes of TKA pain, guiding appropriate treatment for improved patient satisfaction.

Keywords:
AlgorithmsInfectionJoint instabilityKnee arthroplastyPain

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering

Background:

  • Approximately 20% of total knee arthroplasty (TKA) patients report dissatisfaction with results.
  • Common causes for revision surgery include periprosthetic infection, aseptic loosening, instability, and malalignment.
  • Less frequent reasons for reintervention involve osteoarthritis progression, fractures, extensor mechanism issues, wear, and arthrofibrosis.

Purpose of the Study:

  • To present an efficient, reproducible algorithm for analyzing painful total knee arthroplasty (TKA).
  • To guide clinicians in diagnosing the source of discomfort following TKA.

Main Methods:

  • Detailed patient medical history, focusing on pain characteristics and timeline relative to surgery.
  • Comprehensive basic diagnostics: clinical examination, radiological imaging, and infectiological assessments.
  • Further investigations including advanced imaging and infectiological studies if initial diagnostics are inconclusive.

Main Results:

  • The algorithm successfully diagnoses common TKA failures like periprosthetic infection and aseptic loosening in most cases.
  • Identifies the need for advanced diagnostics when initial assessments do not reveal the pain source.
  • Highlights consideration of uncommon causes like extra-articular pathologies, causalgia, or arthrofibrosis.

Conclusions:

  • A systematic approach combining history and diagnostics is crucial for identifying painful TKA causes.
  • Unexplained persistent pain without clear diagnosis does not warrant revision surgery.
  • Patients with unexplained pain require re-evaluation over time.