Which factors affect the ability to kneel following total knee arthroplasty? An outpatient study of 100 postoperative knee replacements

Abstract

Background: Kneeling is an important activity of daily living, holding social, religious and occupational value. Following total knee replacement (TKR), many patients report they are unable to kneel or have been advised not to kneel. Methods: We observed 100 consecutive knee replacements in 79 patients attending outpatient clinic at a minimum 5 months post-TKR. The patients were asked to fill out a questionnaire detailing whether they were able to kneel prior to their knee replacement and whether they thought they were able to kneel since their knee replacement. The patients were then asked to kneel on a padded examination couch and then onto a pillow on the floor for 15 s. Degree of flexion achievable was also recorded. Results: Of the knees with patella resurfacing, 78.6% were able to kneel compared to only 45.6% knees with native patellae. Two-tailed Fisher’s exact test showed this difference to be statistically significant ( p = 0.001). The χ 2 analysis showed that those patients with an achievable flexion of angle of greater than 100° were significantly more likely to be able to kneel than those with a flexion angle of less than 100° ( p = 0.0148). Comparing posterior cruciate ligament (PCL) retaining against PCL sacrificing implants, there was no statistically significant difference in kneeling ability ( p = 0.541). Conclusion: Kneeling remains an important function in patients undergoing TKR, with patella resurfacing significantly improving the likelihood of a patient being able to kneel.

Skin sensory alteration and kneeling ability following cruciate retaining total knee arthroplasty are not affected by the incision position: A randomised controlled trial of simultaneous bilateral surgery

“…4, and therefore underestimating functional kneeling [28]. This is also in keeping with the observation that perceived inability to kneel significantly deviated from objectively assessed kneeling [23,25,30]; Amin et al argued that this misperception may be "the greatest limitation to kneeling after TKA implantation" [30]. Despite difficulty kneeling tends to appear soon after the operation and remain relatively unchanged with the passing of the years [2], kneeling improvement can be achieved with training [5]; 81% of patients who were unable to kneel at 18-24 months postoperatively, attained functional kneeling after a 6-week desensitization home-based protocol [31].…”

“…A 2021 meta-analysis concluded that patients with a transverse incision had increased kneeling odds compared to those with a longitudinal incision [22]. Kneeling ability after TKA is multifactorial, and to a certain extent, controversial [22][23][24][25]. Wilding et al observed that the combination of a CR design and a resurfaced patella showed the better kneeling outcomes, compared to all other combinations involving PS/CR and resurfaced/unresurfaced patellae [25].…”

“…Kneeling ability after TKA is multifactorial, and to a certain extent, controversial [22–25]. Wilding et al observed that the combination of a CR design and a resurfaced patella showed the better kneeling outcomes, compared to all other combinations involving PS/CR and resurfaced/unresurfaced patellae [25].…”

“…Kneeling ability after TKA is multifactorial, and to a certain extent, controversial [22–25]. Wilding et al observed that the combination of a CR design and a resurfaced patella showed the better kneeling outcomes, compared to all other combinations involving PS/CR and resurfaced/unresurfaced patellae [25]. This contrasts with other results reporting better midterm kneeling odds with unresurfaced patellae [26], and a recent review found no association between kneeling ability and patellar resurfacing or knee flexion range [4].…”

Does Partial Knee Replacement Allow Return to High-Demand Activities?

“…Recent studies reported results for PKR, unilateral knee replacement (UKR) [1][2][3][4][5][6][7][8][9][10], contrasts between mobile-bearing versus fixed-bearing, and cemented versus cementless implants. It has been suggested that UKR improves range of motion and functional recovery as well [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The term PKR is used to describe the replacement of the medial compartment, lateral compartment, or patellofemoral joint (PFJ).…”