Kneeling ability after total knee replacement

Abstract

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

Ten-Year Results of the Triathlon Knee Replacement: A Cohort Study

“…Our study further elaborates on this finding to provide evidence that the initial improvement in patient-reported pain, function, stiffness and knee-related quality of life mainly occurs in the first three months after surgery. While satisfaction ratings were high after TKR, little improvement was observed in activity levels and kneeling ability after surgery, which supports findings from previous studies [8,27] and highlights the need for research to evaluate interventions to improve these outcomes. The 10-year Kaplan-Meier survivorship with all-cause revision as the endpoint for the Triathlon TKR of 95.4% (95% confidence interval 91.8-97.5) is consistent with revision rates reported in the National Joint Registry (3.4%; 95% confidence interval 3.2-3.6) [1] and Australian Orthopaedic Association National Joint Replacement Registry (3.8%; 95% confidence interval 3.6-4.0) [28], and survivorship rates in the Finnish Arthroplasty Register (94%; 95% confidence interval 93-95) [29].…”

“…Although many patients have good outcomes after TKR, approximately 20%-30% of patients report long-term pain, functional limitations and dissatisfaction with the outcome of their surgery [5][6][7]. Also, difficulty with more challenging activities, such as kneeling, are common [8]. To meet the growing expectations of patients and to optimise outcomes, manufacturers are continually developing new prosthetic designs.…”

Patients’ Preoperative Expectations of Total Knee Arthroplasty and Satisfaction With Outcomes at One Year: A Prospective Cohort Study

“…These findings are consistent with the importance of kneeling to the performance of many daily activities, some occupations, and many religious and cultural observances (e.g., prayer) (33). However, research to date indicates that 60-80% of primary TKA patients report difficulty or an inability to kneel after TKA (34)(35)(36)(37)(38)(39)(40). Identified barriers to kneeling post-TKA include pain and other sensory changes (e.g., numbness around the incision, patient fear of harming the prosthesis, and lack of information about kneeling after TKA).…”

Influence of component design on in vivo tibiofemoral contact patterns during kneeling after total knee arthroplasty: a systematic review and meta-analysis

“…Of the 26 included studies, only 27% reported consecutive selecting their cohort. Given that only 20% of TKR patients achieve kneeling [48], it is likely that most of the patients included in these studies were high performing and selected for their kneeling ability.…”