Chapter 4

of aseptic I

1-Clinical : I-History :

A complete and accurate history must be done \vhen evaluating a patient who has pain after a primary total knee replacement (10).

Aseptic loosening is -usually presented by pain on weight bearing, pain may be reproduced by applying a varus or valgus stress on the knee.

Itjj^critical to evaluate the type and location of the pain and whether the pain radiatelTTacfoTririlM^

elicited. It is important to assess whether the pain is activity-related or is constant and is not relieved by rest. It is very important to know whether the current pain is similar to the pain experienced before the primary procedure (10).

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 pain (10).

A thorough review of systems must be undertaken to diagnose underlying disease processes such as diabetes mellitus and neurovascular disease (10).

II-General examination :

Physical examination should be complete and should not be limited to the knee. Knee pain may be referred from spinal, abdominal, or hip problems,