An analysis of time and money spent on investigating painful Total Knee Replacements

Painful Total Knee Replacements (TKR) occur in 10-20% of patients according to current literature. Considerable expense is incurred investigating and managing patients presenting with a painful TKR. We studied 41 patients with painful TKRs' who were referred to one of the authors, a knee surgeon with a specialist interest in revision surgery. We calculated the number of appointments, investigations (serological, radiological and microbiological) along with the different managements (both surgical and medical) performed by both the originating surgeon and the specialist knee surgeon. We estimate that an average of 136 £ is spent on each patient. Many of these investigations were repetitive and unnecessary. There is also a considerable difference in the cost of medical and surgical management of painful TKR patients, suggesting that early pain management would be beneficial. We conclude that early referral of patients with a painful TKR to a knee surgeon with specialist interest in revision knee surgery is beneficial and allows to reduced incurred cost to the NHS and also improved patient assessment, investigation and management.