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Part II: Revision Total Knee Arthroplasty   |    
Modes of Failure and Preoperative Evaluation
Khaled J. Saleh, MD, MSc, FRCSC; Charles R. Clark, MD; Peter F. Sharkey, MD; James A. Rand, MD; Gregory A. Brown, MD
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Corresponding author: Khaled J. Saleh, MD, MSc, FRCSC
Department of Orthopaedic Surgery and Clinical Outcome Research Center, University of Minnesota, 420 Delaware Street S.E., Box 492, Minneapolis, MN 55455

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. One or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Smith and Nephew). In addition, a commercial entity (Smith and Nephew) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A video supplement to this article is available to our subscribers at no extra charge on the JBJS web site (www.jbjs.org), for a limited time. The same material is available for purchase from the Video Journal of Orthopaedics (www.vjortho.com; telephone: 805-962-3410).

J Bone Joint Surg Am, 2003 Jan 01;85(suppl 1):S21-S25
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Extract

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.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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