A comparison of kneeling ability after lateral or midline incisions in total knee arthroplasty

Calvert, Nicholas; Milne, Lachlan; Kuster, Markus S.

doi:10.1007/s00590-016-1831-6

Cited by 8 publications

(10 citation statements)

References 13 publications

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“…However, the effects on clinical outcomes are unknown. There have been speculations that lack of sensation around a total knee incision may result in poor patient outcomes, difficulty with day-to-day activities such as kneeling, and overall worse patient satisfaction [11][12][13][14][15]18].…”

Section: Discussionmentioning

confidence: 99%

“…Up to 20% of patients undergoing total knee arthroplasty are not satisfied after the surgery, and although the reasons are still unknown, postoperative numbness may be a contributing factor [9][10][11]. In particular, the inability to kneel after surgery as a result of sensory deficit has been hypothesized to account for patient dissatisfaction [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Sensory Deficit After Total Knee Arthroplasty on Patient Satisfaction and Kneeling Ability

et al. 2021

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Background Skin numbness after total knee arthroplasty is a common complication. The incidence in the literature is variable from 27% to 100%. However, there is conflicting evidence about the consequences of this complication. The purpose of this study was to evaluate if postoperative numbness influenced patient satisfaction or kneeling ability. Methods We recruited patients who underwent a total knee arthroplasty for osteoarthritis one to 5 years before the study. Sensation was measured using a Semmes-Weinstein, 10-gram monofilament. Measurements were taken in several zones around the incision, and overall sensory status was classified as full numbness, partial numbness, and no numbness. Patients completed a questionnaire evaluating their subjective numbness, overall satisfaction, and kneeling ability. We evaluated the effect of numbness on satisfaction and function. Results A total of 96 patients were enrolled. Thirty-four patients were classified as no sensory deficit, 29 as partial deficit, and 33 as full deficit. There were no differences in demographics. Out of all the patients that were found to have a sensory deficit, 54.8% of them did not report any subjective numbness. Average patient-reported satisfaction scores were 8.76/10, 8.97/10, and 8.48/10 for no numbness, partial numbness, and full numbness, respectively. Eleven out of 96 patients noted an inability to kneel. There was no statistical difference for satisfaction scores or kneeling ability between the groups. Conclusion Sensory deficit after total knee arthroplasty is a frequently reported complication. However, the majority of the patients do not report subjective sensory deficits. Postoperative numbness does not appear to affect patient satisfaction or kneeling ability.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effect of Sensory Deficit After Total Knee Arthroplasty on Patient Satisfaction and Kneeling Ability

et al. 2021

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“…One study of 22 patients with 12 midline and 10 lateral skin incisions used the Kneeling Ability Test and the Forgotten Joint Score to determine associations between incision location and kneeling ability. 16 The authors reported that patients with lateral incisions had a significantly higher mean Forgotten Joint Score (100) compared with those with midline incisions (89.1; p ¼ 0.0098). Additionally, the group with lateral incisions had a significantly higher mean Kneeling Ability Test score at 110 degrees of flexion (98.4) compared with patients with midline incisions (56.7) at a mean 28 months after surgery (p ¼ 0.020).…”

Section: Tka Incisions and Kneelingmentioning

confidence: 96%

“…Additionally, the group with lateral incisions had a significantly higher mean Kneeling Ability Test score at 110 degrees of flexion (98.4) compared with patients with midline incisions (56.7) at a mean 28 months after surgery (p ¼ 0.020). 16 However, there was no difference in Kneeling Ability Test scores at 90 degrees of flexion between the 2 groups, and confounding variables, including activity level and occupation, were not considered. Additionally, the small sample limits interpretation of these results.…”

Section: Tka Incisions and Kneelingmentioning

confidence: 98%

Kneeling after Total Knee Arthroplasty

2019

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The ability to kneel is one of the many patient goals after total knee arthroplasty (TKA). Few studies have addressed patients' ability to kneel after TKA as a primary outcome. Given the altered biomechanics of the knee after TKA, the various implant designs, and multiple surgical approaches, there is a need to further understand the patient's kneeling ability after TKA. We evaluated the available literature on this topic to help to guide postoperative care recommendations. Biomechanical data show that the load borne by the patellofemoral joint is elevated significantly at all flexion angles, whereas tibiofemoral articulation pressures are elevated only at 90 to 120 degrees of flexion. However, these increased pressures are rarely borne by prosthetic knees because patients often avoid kneeling after TKA. In patients who do kneel after surgery, data show that increased range of motion promotes improved kneeling performance. Targeted interventions to encourage kneeling after TKA, including preoperative education, have not shown an ability to increase the frequency with which patients kneel after TKA. Reasons for patient avoidance of kneeling are multifaceted and complex. There is no biomechanical or clinical evidence contraindicating kneeling after TKA. There are insufficient data to recommend particular prosthetic designs or surgical approaches to maximize kneeling ability after surgery. Musculoskeletal health care providers should continue to promote kneeling to allow patients to achieve maximum clinical benefit after TKA.

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“…In one small non-randomized study, patients reported that discomfort on kneeling was lower in patients with a lateral incision compared with a midline incision. 53 A randomized controlled trial (RCT) found that patients who received an anterolateral skin incision had a smaller area of cutaneous hypesthesia and better observed kneeling ability compared to patients with an anteromedial skin incision. 54 The findings from these studies indicate that skin incision may have an impact on kneeling ability through numbness.…”

Section: Aetiologymentioning

confidence: 99%

Kneeling ability after total knee replacement

et al. 2019

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Kneeling ability is consistently the poorest patient-rated outcome after total knee replacement (TKR), with 60–80% of patients reporting difficulty kneeling or an inability to kneel. Difficulty kneeling impacts on many activities and areas of life, including activities of daily living, self-care, leisure and social activities, religious activities, employment and getting up after a fall. Given the wide range of activities that involve kneeling, and the expectation that this will be improved with surgery, problems kneeling after TKR are a source of dissatisfaction and disappointment for many patients. Research has found that there is no association between range of motion and self-reported kneeling ability. More research is needed to understand if and how surgical factors contribute to difficulty kneeling after TKR. Discrepancies between patients’ self-reported ability to kneel and observed ability suggests that patients can kneel but elect not to. Reasons for this are multifactorial, including knee pain/discomfort, numbness, fear of harming the prosthesis, co-morbidities and recommendations from health professionals. There is currently no evidence that there is any clinical reason why patients should not kneel on their replaced knee, and reasons for not kneeling could be addressed through education and rehabilitation. There has been little research to evaluate the provision of healthcare services and interventions for patients who find kneeling problematic after TKR. Increased clinical awareness of this poor outcome and research to inform the provision of services is needed to improve patient care and allow patients to return to this important activity. Cite this article: EFORT Open Rev 2019;4:460-467. DOI: 10.1302/2058-5241.4.180085

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A comparison of kneeling ability after lateral or midline incisions in total knee arthroplasty

Cited by 8 publications

References 13 publications

The Effect of Sensory Deficit After Total Knee Arthroplasty on Patient Satisfaction and Kneeling Ability

The Effect of Sensory Deficit After Total Knee Arthroplasty on Patient Satisfaction and Kneeling Ability

Kneeling after Total Knee Arthroplasty

Kneeling ability after total knee replacement

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