Unfortunately, there is no one, single test that can definitively detect a failed total knee replacement. Individual doctor interpretation is much involved.

Have you seen your surgeon about the possibility that your total knee replacement has failed, and he said something like, “It might be loose?”

You get a second opinion from another orthopedic surgeon who says they look okay.

BONE SCAN. You get a bone scan. Your surgeon says the bone scan looks normal. The second opinion is that the bone scan shows “there may be some loosening.”

A third doctor feels the knee, asks questions, then says it’s probably old age or possibly compressed nerves in the lower spine radiating pain to the knee.

Adding to the mess is that the X-rays of your knee replacement have gotten differing interpretations.

“Bone scans are not always helpful tests and can be tricky to interpret,” says Henry Boucher, MD, clinical instructor of Adult Reconstruction, Medstar Union Memorial Orthopaedics, Baltimore, MD.

“There is a high false positive rate if the patient is within two years of the surgery.

“The bone scan needs to be correlated with the X-rays and physical exam. The test should be reviewed by the surgeon and not rely solely on the radiologist report.

“Patients who have two differing opinions unfortunately need a tie-breaker, and if all opinions are different they should rely on reputation and gut feel.”

Medicine is not absolute; much of it is, indeed, based on common sense and gut instinct.

Deciding whether or not you have a failed knee replacement can also be aided by ruling out other possible causes (with tests such as an EMG for spinal nerve compression) of your knee pain and other symptoms associated with loosened implants: swelling and warmth about the knee.

Dr. Boucher’s specialties are hip and knee surgery, replacement and revision, and sports medicine surgery. He has been the recipient of the Golden Apple Award for teaching excellence multiple times.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


Top image: Shutterstock/ChooChin