The initial assessment of pain at the site of a total knee arthroplasty is critical for determining a specific diagnosis and treatment plan. A revision total knee arthroplasty that is performed for an inexact diagnosis is likely to be associated with a poor outcome, while a revision that is performed for a specific cause is more likely to succeed.The evaluation of pain at the site of a total knee arthroplasty requires a complete history, physical examination, and radiographic assessment and may require additional diagnostic studies. A complete and accurate history must be done when evaluating a patient who has pain after a primary total knee replacement. Previous knee operations, and any complications or morbidity associated with the primary total knee replacement, should be carefully documented. Regardless of the absence of symptoms and signs, the possibility of infection must be considered as the cause of the pain. A thorough review of systems must be undertaken to diagnose underlying disease processes such as diabetes mellitus and neurovascular disease. The patient's expectations must be understood.