Evaluation and Management of Painful Total Knee Arthroplasty

Total knee arthroplasty (TKA) is the only treatment that can reconstruct joints severely deformed or destroyed by osteoarthritis (OA) or rheumatoid arthritis, and its effectiveness is undisputed. Although the acute phase of postoperative pain is usually the most intense after TKA, it is almost always relieved within approximately 3 months and decreases over the first year postoperatively [1] (Fig. 83.1). This pain-relieving effect is usually maintained for 20–30 years, but there are cases in which pain persists postoperatively, including implant malpositioning, joint instability, and chronic infection, or new pain arises several years after surgery, including implant loosening, periprosthetic fractures, and delayed infections, that require treatment. These problems require revision surgery, which often improves pain. However, chronic post-surgical pain (CPSP), which does not require reoperation and remains painful, has attracted attention in recent years. In this section, we discuss the pathogenesis of CPSP and the possibility of its prevention and treatment, with a focus on the differential diagnosis of post-TKA pain.