An exploratory study of the long-term impact of difficulty kneeling after total knee replacement

Fletcher, D. L.; Moore, Andrew; Blom, Ashley W; Wylde, Vikki

doi:10.1080/09638288.2017.1410860

Cited by 12 publications

(41 citation statements)

References 31 publications

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“…Difficulty kneeling after TKR can impact on a number of daily household and self-care activities, including cleaning, reaching items from low cupboards or picking them up from the floor, decorating, and getting out of the bath. 30 In Middle Eastern and Eastern cultures, kneeling can be an integral part of many daily activities, including when eating meals. 19,25 These limitations can be disruptive to patients’ daily lives and many patients adapt their activities to minimize the impact, as is a common approach to managing chronic musculoskeletal conditions.…”

Section: Impactmentioning

confidence: 99%

“…31 Examples include sitting on a stool for household chores like low-level cleaning, using assistive devices such as grabbers, and home modifications such as conversion of a bath to a shower. 30 However, despite these adaptions, some patients are unable to continue with some of their usual daily activities because of problems kneeling. In such cases assistance is often needed from friends or family members, or patients may need to employ others to complete these tasks on their behalf.…”

Section: Impactmentioning

confidence: 99%

“…In such cases assistance is often needed from friends or family members, or patients may need to employ others to complete these tasks on their behalf. 30 Consequently, patients may experience a lack of independence and control due to being unable to perform basic household and self-care tasks because of their difficulty with kneeling, which can lead to distress and frustration. 24 Catering for these limitations may also pose a financial burden on patients and social services, and/or a caring burden on family members.…”

Section: Impactmentioning

confidence: 99%

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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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Section: Impactmentioning

confidence: 99%

Section: Impactmentioning

confidence: 99%

Section: Impactmentioning

confidence: 99%

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Kneeling ability after total knee replacement

et al. 2019

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“…that evaluate kneeling as an outcome after TKA consistently show that only 20 to 25% of patients are content with their postoperative ability to kneel. 15,21,25,26 However, the cause of this dissatisfaction is complex. To date, risk factors for organic-kneeling difficulty include concomitant spinal pathology, scar position, pain, and skin hypoesthesia.…”

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confidence: 99%

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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“…To adopt a framing from the transplant literature, one desired outcome may be implicit embodiment—using the implant like the native body part. Like a prosthetic limb, an artificial knee will seldom function exactly like the original one (having a more limited range of motion or being uncomfortable to kneel on, for example) . Unlike a prosthetic limb, a knee has little to no effect on the body's shape, size, or boundaries in the world (peripersonal space), a major focus of recent research on prosthetics .…”

Section: Research Agenda and Clinical Implicationsmentioning

confidence: 99%

Body‐Self Unity With a New Hip or Knee: Understanding Total Joint Replacement Within an Embodiment Framework

Lape

Hudak²,

Davis

et al. 2019

ACR Open Rheumatology

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Medical research increasingly makes use of embodiment concepts to understand how illness disrupts unity of body and self. However, few have applied embodiment concepts in total joint replacement (TJR), an effective treatment for end‐stage arthritis. In considering why a troubling proportion of TJR recipients have continued pain and functional limitation, we ask: what role might be played by the embodied experience of living with an implant? Relevant theoretical models and prior research on embodiment in musculoskeletal health and transplantation are reviewed. Our findings suggest a research agenda with implications for addressing suboptimal outcomes in TJR.

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An exploratory study of the long-term impact of difficulty kneeling after total knee replacement

Cited by 12 publications

References 31 publications

Kneeling ability after total knee replacement

Kneeling ability after total knee replacement

Kneeling after Total Knee Arthroplasty

Body‐Self Unity With a New Hip or Knee: Understanding Total Joint Replacement Within an Embodiment Framework

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