This 2004 JAAOS review systematically addresses how to evaluate a symptomatic TKA before revision. It organizes failure by predominant complaint — pain, stiffness, or instability — and walks through the history, physical exam, imaging, and lab workup needed to pinpoint the specific etiology.
When evaluating a painful TKA, map the pain pattern to its mechanism first — activity-related start-up pain points to loosening, continuous rest pain points to infection or CRPS, and pain only on stairs points to patellar dysfunction.
Never revise without a confirmed diagnosis: a revision without a clear etiology has a high failure rate, and preoperative aspiration (held 4–6 weeks after any antibiotics) is mandatory when infection is on the differential.
This 2004 JAAOS review systematically addresses how to evaluate a symptomatic TKA before revision. It organizes failure by predominant complaint — pain, stiffness, or instability — and walks through the history, physical exam, imaging, and lab workup needed to pinpoint the specific etiology.
When evaluating a painful TKA, map the pain pattern to its mechanism first — activity-related start-up pain points to loosening, continuous rest pain points to infection or CRPS, and pain only on stairs points to patellar dysfunction.
Never revise without a confirmed diagnosis: a revision without a clear etiology has a high failure rate, and preoperative aspiration (held 4–6 weeks after any antibiotics) is mandatory when infection is on the differential.