The painful knee after TKA: a diagnostic algorithm for failure analysis

Abstract

Pain after total knee arthroplasty (TKA) represents a common observation in about 20% of the patients after surgery. Some of these painful knees require early revision surgery within 5 years. Obvious causes of failure might be identified with clinical examinations and standard radiographs only, whereas the unexplained painful TKA still remains a challenge for the surgeon. It is generally accepted that a clear understanding of the failure mechanism in each case is required prior considering revision surgery. A practical 10-step diagnostic algorithm is described for failure analysis in more detail. The evaluation of a painful TKA includes an extended history, analysis of the type of pain, psychological exploration, thorough clinical examination including spine, hip and ankle, laboratory tests, joint aspiration and test infiltration, radiographic analysis and special imaging techniques. It is also important to enquire about the length and type of conservative therapy. Using this diagnostic algorithm, a sufficient failure analysis is possible in almost all patients with painful TKA.

Estimating the Burden of Total Knee Replacement in the United States

“…Because of their continued disability, individuals with pain after total knee replacement may have low levels of physical activity and be at a heightened risk of death due to other comorbidities compared with the general population 32 . Moreover, patients with osteoarthritis who have a total knee replacement may experience pain of a type that is more difficult to diagnose and treat than that in patients without a total knee replacement 11,33 . Given that total knee replacement recipients represent over one-third of adults in the U.S. with diagnosed, symptomatic knee osteoarthritis, refining diagnostic and treatment algorithms should be a priority.…”

Metal artefact reduction in MRI at both 1.5 and 3.0 T using slice encoding for metal artefact correction and view angle tilting

“…[1][2][3] However, the diagnostic accuracy and efficiency of MRI has been compromised by the susceptibility artefacts caused by metal implants. 4,5 Briefly, susceptibility artefacts result from local inhomogeneity of the main magnetic field, which will cause spin dephasing and frequency shifting of the tissue structures surrounding the metal implants. Intravoxel dephasing decreases the signal received and results in hypointense areas on the MR images.…”

Internal Derangements of Joints—Past, Present, and Future

“…After total knee arthroplasty up to 29% of patients have substantial pain at rest or during walking 1 year after surgery, and imaging plays an important part in the evaluation of these patients. 115 For total hip arthroplasty (THA), the results are generally better than for total knee arthroplasty; but in recent years, it has been recognized that one particular type of implants leads to an increased rate of complications 116 : Metal-on-metal implants showed promising initial results, but many of these products have been recalled owing to a large number of cases with metallosis and various complications often described as "adverse local tissue reaction". 117 This can result in aggressive soft tissue destruction and pseudotumors-and MRI has proved to be important in the diagnosis of those complications.…”