Total knee arthroplasty (TKA) is performed for eliminating the pain of the knee joint and regaining the knee joint function in patients with progressed knee osteoarthritis. However, patients and surgeons are unhappy because of ongoing pain in 20% of patients postoperatively. If we take into account the exponentially increasing number of the TKA`s, it is apparent that corrective revisions will take an important place in our practice in the future. The evaluation and management of patients` pain should include a multidisciplinary and systematic approach. A practical 10-step diagnostic algorithm is described for failure analysis in more detail including an extended history, analysis of the type of pain, psychological exploration, thorough clinical examination including spine, hip and ankle, laboratory tests, joint aspiration, infiltration test, radiographic analysis and special imaging techniques. A sufficient failure analysis is possible by using this diagnostic algorithm in almost all patients with painful TKA. Furthermore, revision surgery shouldn`t be performed if no cause is found for the painful TKA.