Typical Pain Patterns in Unhappy Patients After Total Knee Arthroplasty

The primary aim of this study is to assess characteristics of pain in patients with ongoing pain after total knee arthroplasty (TKA). The secondary aim of this study is to identify specific pain patterns and link these to underlying pathologies.

A prospectively collected cohort of 97 painful primary TKA patients was retrospectively evaluated. All patients followed a standardized diagnostic algorithm, which led to a diagnosis that set the indication for revision surgery. Character, location, dynamics, and radiation of pain were systematically assessed and correlated with the underlying pathologies.

Most frequent pain characters were pricking/lancinating (45.7%), pinching/crushing, and dull/heavy (38.6%); 89.5% of all patients localized their knee pain anteriorly; 48.1% reported pain aggravations by descending stairs. Radiating pain was reported in 14% of the patients. Patella-related problems (56.7%) and instability (52.6%) were the most frequent pathologies. Based on correlations between the characteristics 6 specific pain patterns were identified. The most outstanding ones include the following: pattern 1, instability is associated with jumping/shooting, pricking/lancinating and tugging/wrenching pain, and aggravated by chair raising and starting; pattern 6, pain aggravation by descending stairs is associated with anterior and lateral jumping/shooting, tingling/stinging and sharp/lacerating pain character, and TKA positioning and patella baja.

The assessment of painful TKA patients involving specific pain patterns help to further differentiate and define the clinical picture and ultimately the cause of a painful TKA. If the causes of the described complaints are known, a decision for a therapy can be made reliably and sustainably at an early stage before the state of pain becomes chronic.