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

Figures 1, 2, 3, 4, 5, 6, 7 and 8 show a representative case with painful TKA: 49 year old active police men, distal tibia fracture in 1980, scope 03/2008, primary TKA (mobile rotating platform) in 05/2009 for posttraumatic OA, post operative ROM 0-0-120° but disturbed gait, instability, recurrent effusion, pain during stair climbing and raising a chair, progression of pain. In 05/2010 isolated femur component revision for femur malrotation; post operative further progression of symptoms with limited flexion and walking distance. Referred to our institution, infection excluded, secondary depression, lost his job, massive disturbed gait, 50% quadriceps atrophy, multiple knee trigger points, but no signs for CRPS, limited flexion 0–0–80° with pain at max flexion, typical lateral flexion gap instability but no patella maltracking or anterior-posterior instability. In 01/2011 complete revision using a standard revision system and fix bearing PS with correction of femur malrotation, restoring posterior offset and lowering joint line. At 3 months post operative outcome is good with flexion 0–0–120°, stable knee, little swelling, normal gait and residual pain only, still working on muscular atrophy and not yet able to go back in his job.