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J Knee Surg 2020; 33(02): 138-143
DOI: 10.1055/s-0038-1676801
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Kneeling after Total Knee Arthroplasty

Raj M. Amin
1   Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
,
Vikram Vasan
2   Krieger School of Arts and Sciences, The Johns Hopkins University, Baltimore, Maryland
,
Julius K. Oni 
3   Division of Adult Reconstruction, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
› Author Affiliations Funding None.
Further Information

Publication History

30 August 2018

11 November 2018

Publication Date:
02 January 2019 (online)

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Abstract

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.

Keywords

deep flexion - double-stance kneeling - kneeling - outcomes - total knee arthroplasty - single-stance kneeling
 

  • References

  • 1 Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004; 86-A (05) 963-974
    PubMedGoogle Scholar
  • 2 Weiss JM, Noble PC, Conditt MA. , et al. What functional activities are important to patients with knee replacements?. Clin Orthop Relat Res 2002; (404) 172-188
    PubMedGoogle Scholar
  • 3 Lee TQ. Biomechanics of hyperflexion and kneeling before and after total knee arthroplasty. Clin Orthop Surg 2014; 6 (02) 117-126
    CrossrefPubMedGoogle Scholar
  • 4 Palmer SH, Servant CT, Maguire J, Parish EN, Cross MJ. Ability to kneel after total knee replacement. J Bone Joint Surg Br 2002; 84 (02) 220-222
    CrossrefPubMedGoogle Scholar
  • 5 Ulbrich J, Raheja A, Alexander NB. Body positions used by healthy and frail older adults to rise from the floor. J Am Geriatr Soc 2000; 48 (12) 1626-1632
    CrossrefPubMedGoogle Scholar
  • 6 Clement ND, MacDonald D, Patton JT, Burnett R. Post-operative Oxford knee score can be used to indicate whether patient expectations have been achieved after primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23 (06) 1578-1590
    CrossrefPubMedGoogle Scholar
  • 7 Ha CW, Ravichandran C, Lee CH, Kim JH, Park YB. Performing high flexion activities does not seem to be crucial in developing early femoral component loosening after high-flexion TKA. BMC Musculoskelet Disord 2015; 16: 353
    CrossrefPubMedGoogle Scholar
  • 8 Hassaballa MA, Porteous AJ, Learmonth ID. Functional outcomes after different types of knee arthroplasty: kneeling ability versus descending stairs. Med Sci Monit 2007; 13 (02) CR77-CR81
    PubMedGoogle Scholar
  • 9 Hofstede SN, Nouta KA, Jacobs W. , et al. Mobile bearing vs fixed bearing prostheses for posterior cruciate retaining total knee arthroplasty for postoperative functional status in patients with osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev 2015; (02) CD003130
    PubMedGoogle Scholar
  • 10 Sharkey PF, Miller AJ. Noise, numbness, and kneeling difficulties after total knee arthroplasty: is the outcome affected?. J Arthroplasty 2011; 26 (08) 1427-1431
    CrossrefPubMedGoogle Scholar
  • 11 Smith TO, Hing CB, Davies L, Donell ST. Fixed versus mobile bearing unicompartmental knee replacement: a meta-analysis. Orthop Traumatol Surg Res 2009; 95 (08) 599-605
    Google Scholar
  • 12 Spencer BA, Cherian JJ, Margetas G. , et al. Patellar resurfacing versus circumferential denervation of the patella in total knee arthroplasty. Orthopedics 2016; 39 (05) e1019-e1023
    CrossrefPubMedGoogle Scholar
  • 13 Tolk JJ, van der Steen MC, Janssen RPA, Reijman M. Total knee arthroplasty: What to expect? A survey of the members of the Dutch Knee Society on long-term recovery after total knee arthroplasty. J Knee Surg 2017; 30 (06) 612-616
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Von Keudell A, Sodha S, Collins J, Minas T, Fitz W, Gomoll AH. Patient satisfaction after primary total and unicompartmental knee arthroplasty: an age-dependent analysis. Knee 2014; 21 (01) 180-184
    CrossrefPubMedGoogle Scholar
  • 15 Artz NJ, Hassaballa MA, Robinson JR, Newman JH, Porteous AJ, Murray JR. Patient reported kneeling ability in fixed and mobile bearing knee arthroplasty. J Arthroplasty 2015; 30 (12) 2159-2163
    CrossrefPubMedGoogle Scholar
  • 16 Calvert N, Milne L, Kuster M. A comparison of kneeling ability after lateral or midline incisions in total knee arthroplasty. Eur J Orthop Surg Traumatol 2016; 26 (08) 915-919
    CrossrefPubMedGoogle Scholar
  • 17 Clement ND, Green K, Murray N, Duckworth AD, McQueen MM, Court-Brown CM. Undisplaced intracapsular hip fractures in the elderly: predicting fixation failure and mortality. A prospective study of 162 patients. J Orthop Sci 2013; 18 (04) 578-585
    CrossrefPubMedGoogle Scholar
  • 18 Coughlin KM, Incavo SJ, Doohen RR, Gamada K, Banks S, Beynnon BD. Kneeling kinematics after total knee arthroplasty: anterior-posterior contact position of a standard and a high-flex tibial insert design. J Arthroplasty 2007; 22 (02) 160-165
    CrossrefPubMedGoogle Scholar
  • 19 Hassaballa M, Artz N, Weale A, Porteous A. Alteration in skin sensation following knee arthroplasty and its impact on kneeling ability: a comparison of three common surgical incisions. Knee Surg Sports Traumatol Arthrosc 2012; 20 (10) 1983-1987
    CrossrefPubMedGoogle Scholar
  • 20 Hassaballa MA, Porteous AJ, Newman JH. Observed kneeling ability after total, unicompartmental and patellofemoral knee arthroplasty: perception versus reality. Knee Surg Sports Traumatol Arthrosc 2004; 12 (02) 136-139
    CrossrefPubMedGoogle Scholar
  • 21 Hassaballa MA, Porteous AJ, Newman JH, Rogers CA. Can knees kneel? Kneeling ability after total, unicompartmental and patellofemoral knee arthroplasty. Knee 2003; 10 (02) 155-160
    CrossrefPubMedGoogle Scholar
  • 22 Usiskin IM, Yang HY, Deshpande BR. , et al. Association between activity limitations and pain in patients scheduled for total knee arthroplasty. BMC Musculoskelet Disord 2016; 17: 378
    CrossrefPubMedGoogle Scholar
  • 23 van der Ven PJP, van de Groes S, Zelle J, Koëter S, Hannink G, Verdonschot N. Kneeling and standing up from a chair as performance-based tests to evaluate knee function in the high-flexion range: a randomized controlled trial comparing a conventional and a high-flexion TKA design. BMC Musculoskelet Disord 2017; 18 (01) 324
    CrossrefPubMedGoogle Scholar
  • 24 White L, Stockwell T, Hartnell N, Hennessy M, Mullan J. Factors preventing kneeling in a group of pre-educated patients post total knee arthroplasty. J Orthop Traumatol 2016; 17 (04) 333-338
    CrossrefPubMedGoogle Scholar
  • 25 Fletcher D, Moore AJ, Blom AW, Wylde V. An exploratory study of the long-term impact of difficulty kneeling after total knee replacement. Disabil Rehabil 2019; 41 (07) 820-825
    CrossrefPubMedGoogle Scholar
  • 26 Kievit AJ, van Geenen RC, Kuijer PP, Pahlplatz TM, Blankevoort L, Schafroth MU. Total knee arthroplasty and the unforeseen impact on return to work: a cross-sectional multicenter survey. J Arthroplasty 2014; 29 (06) 1163-1168
    CrossrefPubMedGoogle Scholar
  • 27 Barnes CL, Sharma A, Blaha JD, Nambu SN, Carroll ME. Kneeling is safe for patients implanted with medial-pivot total knee arthroplasty designs. J Arthroplasty 2011; 26 (04) 549-554
    CrossrefPubMedGoogle Scholar
  • 28 Schai PA, Gibbon AJ, Scott RD. Kneeling ability after total knee arthroplasty. Perception and reality. Clin Orthop Relat Res 1999; (367) 195-200
    PubMedGoogle Scholar
  • 29 Nakamura S, Sharma A, Kobayashi M. , et al. 3D in vivo femoro-tibial kinematics of tri-condylar total knee arthroplasty during kneeling activities. Knee 2014; 21 (01) 162-167
    CrossrefPubMedGoogle Scholar
  • 30 Hassaballa M, Vale T, Weeg N, Hardy JR. Kneeling requirements and arthroplasty surgery. Knee 2002; 9 (04) 317-319
    CrossrefPubMedGoogle Scholar
  • 31 Wilkens KJ, Duong LV, McGarry MH, Kim WC, Lee TQ. Biomechanical effects of kneeling after total knee arthroplasty. J Bone Joint Surg Am 2007; 89 (12) 2745-2751
    CrossrefPubMedGoogle Scholar
  • 32 Huang CH, Hsu LI, Lin KJ. , et al. Patellofemoral kinematics during deep knee flexion after total knee replacement: a computational simulation. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 3047-3053
    CrossrefPubMedGoogle Scholar
  • 33 Seon JK, Park SJ, Lee KB, Yoon TR, Kozanek M, Song EK. Range of motion in total knee arthroplasty: a prospective comparison of high-flexion and standard cruciate-retaining designs. J Bone Joint Surg Am 2009; 91 (03) 672-679
    CrossrefPubMedGoogle Scholar
  • 34 Hofer JK, Gejo R, McGarry MH, Lee TQ. Effects of kneeling on tibiofemoral contact pressure and area in posterior cruciate-retaining and posterior cruciate-sacrificing total knee arthroplasty. J Arthroplasty 2012; 27 (04) 620-624
    CrossrefPubMedGoogle Scholar
  • 35 Incavo SJ, Mullins ER, Coughlin KM, Banks S, Banks A, Beynnon BD. Tibiofemoral kinematic analysis of kneeling after total knee arthroplasty. J Arthroplasty 2004; 19 (07) 906-910
    CrossrefPubMedGoogle Scholar
  • 36 Hamai S, Miura H, Higaki H. , et al. Kinematic analysis of kneeling in cruciate-retaining and posterior-stabilized total knee arthroplasties. J Orthop Res 2008; 26 (04) 435-442
    CrossrefPubMedGoogle Scholar
  • 37 Shimmin A, Martinez-Martos S, Owens J, Iorgulescu AD, Banks S. Fluoroscopic motion study confirming the stability of a medial pivot design total knee arthroplasty. Knee 2015; 22 (06) 522-526
    CrossrefPubMedGoogle Scholar
  • 38 Ackmann T, Von Düring M, Teske W, Ackermann O, Muller P, Von Schulze Pellengahr C. Anatomy of the infrapatellar branch in relation to skin incisions and as the basis to treat neuropathic pain by cryodenervation. Pain Physician 2014; 17 (03) E339-E348
    CrossrefPubMedGoogle Scholar
  • 39 Zhang Z, Zhu W, Zhang W. High-flexion posterior-substituting versus cruciate-retaining prosthesis in total knee arthroplasty: functional outcome, range of motion and complication comparison. Arch Orthop Trauma Surg 2015; 135 (01) 119-124
    CrossrefPubMedGoogle Scholar
  • 40 Kolisek FR, McGrath MS, Marker DR. , et al. Posterior-stabilized versus posterior cruciate ligament-retaining total knee arthroplasty. Iowa Orthop J 2009; 29: 23-27
    PubMedGoogle Scholar
  • 41 Grassi A, Compagnoni R, Ferrua P. , et al. Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses. Knee Surg Sports Traumatol Arthrosc 2018; 26 (11) 3206-3218
    CrossrefPubMedGoogle Scholar
  • 42 Longo UG, Ciuffreda M, Mannering N, D'Andrea V, Cimmino M, Denaro V. Patellar resurfacing in total knee arthroplasty: systematic review and meta-analysis. J Arthroplasty 2018; 33 (02) 620-632
    CrossrefPubMedGoogle Scholar
  • 43 Nizard RS, Biau D, Porcher R. , et al. A meta-analysis of patellar replacement in total knee arthroplasty. Clin Orthop Relat Res 2005; (432) 196-203
    PubMedGoogle Scholar
  • 44 Maradit-Kremers H, Haque OJ, Kremers WK. , et al. Is selectively not resurfacing the patella an acceptable practice in primary total knee arthroplasty?. J Arthroplasty 2017; 32 (04) 1143-1147
    CrossrefPubMedGoogle Scholar