Patients present with painful total knees and the diagnosis is not always easy.  Here I will talk about what I do in my workup of these patients.  I go back to before surgery and get early xrays and listen to what conservative treatments they have had.  A detailed peri-operative history and any complications is important.  Labs, aspirations and special tests all have a role.  The differential is large and you have to have a good plan an algorithm to go through all of the potential causes of pain.

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