Factors preventing kneeling in a group of pre-educated patients post total knee arthroplasty

White, Leigh; Stockwell, Theresa M; Hartnell, Nicholas J; Hennessy, Melissa; Mullan, Judy

doi:10.1007/s10195-016-0411-1

Cited by 22 publications

(16 citation statements)

References 22 publications

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“…22 Additionally, preoperative patient education about kneeling after TKA has not resulted in substantial improvement in the proportion of patients who report kneeling ability after TKA. 24 Therefore, patient perceptions of which activities are acceptable after TKA should be assessed to allow for maximal surgical benefit.…”

Section: Biomechanics Of Kneelingmentioning

confidence: 99%

“…3,27 However, knee stability has not been implicated in the inability to kneel. 24 Psychological factors and patient education are increasingly reported as primary drivers of patients' inability to kneel or dissatisfaction with kneeling after surgery. 4,28 Given the lack of consensus regarding factors affecting kneeling and outcomes associated with kneeling after TKA, we evaluated the available empirical and kinematic data to guide postoperative recommendations.…”

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confidence: 99%

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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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Section: Biomechanics Of Kneelingmentioning

confidence: 99%

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confidence: 99%

Kneeling after Total Knee Arthroplasty

2019

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“…The novelty of current study is that giving an attention to healthcare professionals as well as TKA patients regarding an important knee function question, which remains improperly answered because of limited studies in the literature [11,12]. As the question remains before and after TKA'' is kneeling safe and viable function after TKA?''…”

Section: Discussionmentioning

confidence: 99%

Perceptions of Kneeling Ability After TKA

Benfayed¹,

Moran²,

Simpson³

et al. 2017

Orthop Muscular Syst

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Background: Kneeling is an important function for many activities of daily life including employment, social and religious practices. Different activities require different patterns of kneeling (upright and high flex kneeling patterns). This study investigates patients' perception of kneeling ability. Methods:Three hundred consecutive patients undergoing Total Knee Arthroplasty (TKA) in Royal Infirmary of Edinburgh received patient specific kneeling ability questionnaires along with the Oxford Knee Score (OKS) preoperatively and one year after surgery. The 'kneeling ability questionnaire was constructed to determine: (1) The ability to adopt one or more of 4 kneeling positions demonstrated in 4 simple illustrations rated on a 4-point Likert scale (0= Impossible, 1=with extreme difficulty, 2=with moderate difficulty, 3=with little difficulty, 4=Easily) pre-operatively and one-year postoperative. The kneeling positions represent different degrees of knee flexion and knee contact with the ground. (2) If unable to kneel, the reason for the inability to kneel. (3) Specific instructions about kneeling given by health care professionals before and after surgery.Results: 251 patients (147 women and 104 men) responded and completed the questionnaires (response rate 84%). The main reasons for kneeling difficulties were pain (111/251), medical problems (77/251), and numbness around the knee (41/251). Most of the patients (147/251 i.e., 63.6%), received advice regarding kneeling before or after TKA; 132 patients (59%) were advised not to kneel after TKAs from the arthroplasty nurse practitioner, 45 patients (20%) received the advice not to kneel after TKAs from their consultants, 29 patients (13%) received the advice not to kneel from their GPs and 9 patients (4%) received the advice not to kneel from their physiotherapists. One hundred and eighty three patients responded to both OKS kneeling question and the kneeling questionnaire preoperatively, and one year after surgery, 15 patients could kneel easily before TKA, this number decreased to 5 patients after TKA; on the other hand 51 patients answered impossible to kneel before TKA and this number increased to 72 patients after TKA. The positive correlation noticed between the OKS kneeling question and the kneeling questionnaire responses showed the strong correlation with the upright kneeling patterns. The data suggest that a high percentage of TKA patients experience postoperative kneeling difficulties. 96% of patients responded that were advised by a health care professionals not to kneel. Conclusion:1. Kneeling is a problem to many patients after TKA. This may have important consequences for work/religious and social life after TKA. 2. Patients are frequently advised not to kneel after TKA. The higher percentage could be because of miss-understanding of the advice. 3. Kneeling questionnaire correlates well with OKS kneeling question. 4. Kneeling is not a single position of the knee and can be interpreted in different ways by different patients.

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“…A randomised controlled trial found that a 30-minute physiotherapy intervention delivered at 6 weeks post-surgery improved patient-reported kneeling ability at 12 months after unicompartmental knee replacement [15]. A cohort study suggests that preoperative kneeling advice may improve post-operative kneeling ability [28].…”

Section: Discussionmentioning

confidence: 99%

Persistent pain after knee replacement: do factors associated with pain vary with degree of patient dissatisfaction?

Howells

Murray

Wylde

et al. 2016

Osteoarthritis and Cartilage

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Link to publication record in Explore Bristol Research PDF-document This is the author accepted manuscript (AAM). The final published version (version of record) is available online via ELSEVIER at http://www.sciencedirect.com/science/article/pii/S1063458416301996 . Please refer to any applicable terms of use of the publisher. University of Bristol -Explore Bristol Research General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. ABSTRACT PurposeTo explore the long-term impact of difficulty with kneeling and how healthcare services could be improved to help patients kneel after total knee replacement. MethodsTelephone interviews were conducted with 56 patients who had extreme difficulty kneeling at 7-10 years after knee replacement. Patients were asked about reasons for difficulty kneeling, how it impacted upon their lives, and experiences of healthcare services. Responses were recorded on a standardised proforma and a descriptive content analysis performed. ResultsMost people had difficulty kneeling because of pain or discomfort in the replaced knee. Many patients described this limitation affected their daily lives, including housework, gardening, religious practices, leisure activities and getting up after a fall. Patients often adapted to these limitations by finding alternatives to kneeling, assistance from others or home adaptations.Many patients had accepted that they could not kneel, however some still expressed frustrated. Few patients had consulted with healthcare professionals about kneeling difficulties, and unmet needs included the provision of information about kneeling and postoperative physiotherapy. InterpretationThis study provides an initial insight into how difficulty kneeling after knee replacement impacts upon patientsand the need for better healthcare provision.

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Factors preventing kneeling in a group of pre-educated patients post total knee arthroplasty

Cited by 22 publications

References 22 publications

Kneeling after Total Knee Arthroplasty

Kneeling after Total Knee Arthroplasty

Perceptions of Kneeling Ability After TKA

Persistent pain after knee replacement: do factors associated with pain vary with degree of patient dissatisfaction?

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