Case of the Month #13: Persistent pain following total knee replacement

Published: 28/02/2022


Mrs B was referred to the Pain service.  She was 75 years of age and had undergone total right knee replacement five years previously. Prior to the surgery she had suffered from pain in her right knee for many years and indeed had had an arthroscopy which had confirmed tricompartment osteoarthritis three years prior to that.  Mrs B was never satisfied with the outcome of the knee replacement.  In the first few months following surgery it was very stiff and it took many months of intensive physiotherapy including a manipulation of the joint under anaesthesia to get a decent range of movement in the joint. However, pain persisted.  
Mrs B reports that she has a constant drone of pain deep within the joint which she scored as 7 out of 10 on a verbal rating scale. She also reported that she occasionally had lancinating pain to the side of the knee and right calf.  As she struggling to walk smoothly, she was also reporting increasing low lumbar back pain particularly to the left paraspinal area, at times radiating on to the anterior aspect of the left thigh.

Before continuing, consider the following questions:


  • Is there any other information you would like to know?
  • What are the potential differential diagnoses?
  • Are there any clinical patient measures that would be useful at this stage?
  • Are there further investigations that would be helpful?
  • Would this patient benefit from evaluation by another speciality?