Aims and Objectives: About 20% of patients after total knee arthroplasty (TKA) are not satisfied nor pain free. After a challenging diagnostic workup it is not unusual that revision surgery becomes necessary. There is a general consensus that knee revision surgery should only be performed when the causes of the complaints are identified. In the clinical diagnostic process the detection of pain patterns that are typical for specific pathologies is paramount. Revision surgeons in clinical practice are well aware of some pain patterns but to date there is no study dealing with detection and identification of typical pain patterns in patients with painful TKA. The purpose of this study is the detection and definition of typical pain patterns in patients with painful TKA and the assignment to typical pathologies such as instability, stiffness, loosening, patellofemoral overstuffing and mechanical dysfunctions. Materials and Methods: A consecutive number of 129 patients, which were seen in the consultation at a specialized knee centre between 2012 and 2017 due to painful primary knee arthroplasty and whose diagnostic workup resulted in revision surgery were included. Defined criteria were retrospectively assessed from pre-existing patient documentation, statistic analysis (chi-squared test) and the assignment to the underlying pathology was performed. The criteria include localisation, intensity and character of pain, position and type of the prosthetic components, postoperative course, indication for revision surgery and demographic data such as age of the patient at primary surgery, sex, time between primary and revision surgery, socioeconomic status. Results: Typical pain patterns were defined and assigned to specific pathologies. Significant correlation was shown between localisation, intensity and character of pain and demographic data, type and position of the prosthetic components, surgical technique as well as the underlying cause for revision surgery such as instability, stiffness, loosening, patellofemoral overstuffing and mechanical dysfunction. Conclusion: The detection and definition of typical pain patterns in patients with pain after TKA and the assignment of identified pathologies will be applied in the improvement of the diagnostic process. Only when the exact cause of pain is determined, the therapy can be successful. The results of this study allow improving the clinical diagnostic process of patients with pain after TKA and help to enhance the indications for possible revision surgery.