My Total Knee Hurts
Forum Post by: Randall Pape MPAS, PA-C, South Central Regional Director
My Total Knee Hurts…….now what?
I work in an adult reconstruction practice and we have a large referral base for painful/failed Total Knee Arthoplasty (TKA). The primary rule of thought in evaluation of the painful TKA is that it is infected until proven otherwise. In our practice, the evaluation of patients with painful TKA includes a thorough clinical evaluation, laboratory analysis as well as obtaining plain, weight bearing radiographs of the ipsilateral hip. Occasionally, patients who have had TKA, and even revision TKA’s have never had radiographs of the hip performed. Hip OA may present solely as anterior knee pain, without any pain in the hip. It is often hard to convince these patients that their hip arthritis is the cause of their knee pain after they have been through joint replacement surgery (and in some cases revision arthroplasty). These individuals are sent for a simple diagnostic injection of their hip and asked to pay attention to their knee pain. More often than not, they will return for follow-up perplexed that their hip arthritis has been causing their knee pain all along. Having seen a significant number of painful TKA’s caused by hip arthritis, we make it a point to obtain hip radiographs on all of our patients prior to proceeding with a TKA. If there is evidence of degenerative changes we will send these patients to have a diagnostic injection of their hip prior to proceeding with surgery to better delineate where their pain is mediated from.
Sam Dyer, PA-C, MHS