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
