الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Although total knee arthroplasty predictably provides relief of pain and good functional results, a number of potential etiologies exist for a painful total knee replacement. It is paramount to exclude infection whenever evaluating a painful total knee. Results of treatment will not be satisfactory if the mechanism of pain or knee failure is not understood. There is no role for exploratory revision surgery. A complete history, physical examination, and thoughtful differential diagnosis help make the diagnosis and develop an effective treatment paradigm.There is a consensus in the literature that the exploration should always start with an extended history, sufficient clinical examination, standard laboratory tests and standard radiographs. The clinical picture of a painful knee after TKA may significantly vary. Nevertheless, there are some typical clinical patterns described. The intra and extraarticular symptoms are related to the disturbed biomechanics of the knee and needs a full understanding of the type of prosthesis (constraint, conformity, mobile or fixed bearing) and the biomechanical consequences of the failure mechanism(s).After history and clinical examination, every knee should have routine laboratory testing. Unfortunately, for infection diagnosis, a negative laboratory test (including WBC, ESR and CRP) is not excluding a low-grade infection. About 10% of these negative cases with the typical clinical symptoms might have an infection. New markers like IL-6 will be helpful in combination with CRP and might further increase the accuracy of laboratory tests to rule out infection.