Differential Diagnosis for Burning Sensation on the Lateral Aspect of the Tibia after Knee Replacement

• Single Most Likely Diagnosis
  • Periprosthetic neuropathy or nerve irritation: This condition can occur due to the surgical procedure itself or as a result of component malpositioning, leading to irritation or damage to the peroneal nerve, which runs along the lateral aspect of the tibia. The timing, about a year after surgery, could be related to scar tissue formation or component loosening that affects nearby nerves.
• Other Likely Diagnoses
  • Component loosening or malposition: Loosening or improper positioning of the knee replacement components can lead to abnormal mechanical stresses on the surrounding bone and soft tissues, potentially causing pain and burning sensations.
  • Heterotopic ossification: Although less common, the formation of bone in soft tissues around the knee replacement can cause pain and discomfort, including burning sensations, especially if it involves areas near nerves.
  • Infection: Low-grade infection or chronic inflammation around the prosthesis can cause a variety of symptoms, including pain, swelling, and potentially burning sensations due to the body's immune response.
• Do Not Miss Diagnoses
  • Deep vein thrombosis (DVT) or pulmonary embolism (PE): Although less directly related to the burning sensation, these conditions can present with leg pain and swelling. Given the history of recent surgery, there's an increased risk, and missing these diagnoses could be fatal.
  • Osteolysis: The progressive bone loss around the implant due to wear and tear of the prosthetic components can lead to structural weakness, pain, and potentially neurological symptoms if nerves are affected.
• Rare Diagnoses
  • Complex regional pain syndrome (CRPS): A rare condition characterized by chronic pain, inflammation, and hypersensitivity, which can occur after trauma or surgery, including knee replacement.
  • Neuroma formation: The growth of a nerve tumor (neuroma) near the site of the knee replacement could cause localized pain and burning sensations, although this would be an uncommon complication.
  • Stress fracture: A fracture in the tibia due to altered biomechanics post-surgery could cause pain but would be less likely to present as a burning sensation unless there was associated nerve irritation.