Kneeling after Total Knee Arthroplasty

Amin, Raj M.; Vasan, Vikram; Oni, Julius K.

doi:10.1055/s-0038-1676801

Cited by 10 publications

(6 citation statements)

References 41 publications

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“…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].…”

Section: Discussionsupporting

confidence: 78%

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

Barroso Rosa,

Wilkinson,

McEwen

et al. 2023

J. exp. orthop.

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Purpose The purpose of this randomised controlled trial was to assess the impact of skin incision location on the patients’ ability to kneel. Methods A total of 29 patients undergoing bilateral total knee arthroplasty (58 knees) were randomised to receive a lateral or midline incision, with the contralateral limb receiving the alternative option. Cruciate retaining implants were used in all cases by three experienced arthroplasty surgeons. The primary outcome measures assessed functional ability to kneel using an innovative five-point kneeling scale, preferred knee to kneel on and the area of cutaneous sensory loss around the incision at 6 weeks, 6 months and 12 months. Secondary outcome measures were the OKS, KOOS JR, FJS and EQ5D patient reported outcome measures (PROMS), length of surgical scar, overall knee preference and range of motion (ROM). Results There were no significant differences between the two groups for any primary or secondary outcome measures. Flexion range however, had a significant positive correlation with kneeling score (r = 0.335, p = 0.010). The kneeling score increased at each time point after surgery and was significantly greater at 12 months than preoperatively (2.7 v 3.5, p = 0.015). The area of sensory loss lateral to the incision was significantly less at 6 and 12 months than at 6 weeks (43.6cm2 and 40.1cm2 v 84.1cm2, p < 0.0001). Conclusion The ability to kneel following cruciate retaining total knee arthroplasty is not affected by the incision position but by time and flexion range. TKA improves the ability to kneel by 12 months post-surgery. Sensory loss lateral to the incision reduces with time. Level of evidence Therapeutic Level 2.

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Section: Discussionsupporting

confidence: 78%

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

Barroso Rosa,

Wilkinson,

McEwen

et al. 2023

J. exp. orthop.

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“…However, it is important to note that this accelerated wear has not been independently shown in the literature. 21 Similarly, Huang et al 22 analyzed the kinematics of the patellofemoral joint after TKA using a computer model. They proposed that high flexion angle in addition to applying large forces on the tibial tubercle (such as kneeling or squatting) can cause maltracking of the patella and therefore possible accelerated polyethylene wear.…”

Section: Discussionmentioning

confidence: 99%

“…However, again, no literature has demonstrated patellofemoral polyethylene failure caused by kneeling. 21 To date, no high-level evidence exists in the literature demonstrating whether kneeling truly harms the prosthesis or not. The authors believe that when kneeling at 90 degrees of flexion, the pressure point is mainly targeted on the anatomical tibial tubercle and not directly on the implant, indicating that it is unlikely to directly damage the implant.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Patient Occupation, Hobbies, and Body Mass Index on Kneeling after Total Knee Arthroplasty

et al. 2019

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A common patient concern after total knee arthroplasty (TKA) is the ability to kneel. Kneeling may have a substantial impact on the patients' ability to perform many activities of daily living, occupations, and hobbies. The purpose of this study was to quantify the percentage of patients able to kneel after TKA after 2 years and to evaluate preoperative patient characteristics that influence the patient's perceived ability to kneel after TKA such as obesity, occupation, and hobbies. We retrospectively assessed a cohort of 404 patients who underwent primary TKA with patellar resurfacing. We assessed the impact of patient hobbies, occupation, employment status, and body mass index (BMI) on the kneeling capacity and patient-reported satisfaction. Univariate analysis was performed using Fisher's exact test, and multivariate analysis was performed using logistic regression with multiple imputations. A total of 404 patients were included. Sixty percent of patients were unable to kneel after TKA. Males (p < 0.001) and patients with occupations or hobbies requiring kneeling (p < 0.05) were more likely to kneel after surgery. We identified an inverse relationship between BMI and the ability to kneel. No correlation was found between duration and frequency of kneeling relative to patient-reported ease or difficulty with kneeling. Patient-reported factors that prevented patients from kneeling were pain, physical inability, and fear of damaging the prosthesis. Patient education may be helpful in improving patient expectations about kneeling after surgery. A small but significant difference in subjective patient satisfaction was observed when comparing patients able to kneel with those unable to kneel.

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“…20 The number of patients is small which reflects the incidence of isolated patellofemoral arthritis and our selection criteria which excluded symptoms on the opposite side. Our functional assessment involves deep flexion activity like kneeling and squatting which is a reflection of patellofemoral kinematics of the knee prosthesis [21][22][23] and are indicators of patient satisfaction. 24,25 However, we have not taken into account other factors like muscle control and limb stability which contribute to such activity.…”

Section: Discussionmentioning

confidence: 99%

Has the modern design of Attune total knee replacement improved outcome in patients with isolated patellofemoral arthritis?

Ashraf

Iqbal

Senevirathana

et al. 2020

J Orthop Surg (Hong Kong)

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Introduction and Aim: Modern knee replacements aim to improve patient function in arthritis affecting different compartments of the knee. This study evaluates the Patient Reported Outcome Measure (PROM) and functional outcome of a modern total knee replacement (Attune, DePuy) in patients with isolated patellofemoral arthritis. Methods: A total of 50 consecutive patients with isolated unilateral patellofemoral arthritis having had Attune total knee replacements at a single institution between 2010 and 2016 were prospectively studied. Five patients who developed symptoms on the opposite side during the study and two patients lost to follow-up were excluded. One patient needed early revision for loosening, leaving a total of 42 patients to be followed up over a period of 4 years. The Oxford Knee score (OKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) recorded pre-operatively and at follow-up was compared. A Functional assessment at around 8 months after operation was undertaken. Results: At average follow-up of 24 months the mean OKS score improved by 15 points and the KOOS score improved by 20 points. Final KOOS sub-score for Pain was 80, Symptom 80, and ADL 82, Sports & Recreation 32 and QOL 60. Functional assessment at mean 8 months showed that a significant number of patients were able to Kneel (50%); Sit cross legged (23%); sit on their heel (23%) and were able do a single leg dip test (86%). Conclusion: This unique study of a modern design total knee replacement (Attune) in patients with isolated unilateral patellofemoral arthritis shows good PROM scores at 2 years and good functional assessment results at 8 months. The PROM scores are marginally better than the published results with Attune’s predecessor, in a similar cohort of patients, but falls short of the published results of patellofemoral replacement implants. Large randomised comparative studies between traditional and the modern implant design is recommended to answer the question if design modification has influenced clinical outcome in patients with patellofemoral arthritis.

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Kneeling after Total Knee Arthroplasty

Cited by 10 publications

References 41 publications

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

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

The Effects of Patient Occupation, Hobbies, and Body Mass Index on Kneeling after Total Knee Arthroplasty

Has the modern design of Attune total knee replacement improved outcome in patients with isolated patellofemoral arthritis?

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