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J Knee Surg 2021; 34(07): 772-776
DOI: 10.1055/s-0039-3400740
Original Article

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

Karim G. Sabeh
1   Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
,
Victor H. Hernandez
2   Department of Orthopaedic Surgery and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
,
Wayne B. Cohen-Levy 
2   Department of Orthopaedic Surgery and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
,
Alvin Ong
3   Department of Orthopaedic Surgery, Rothman Institute of Orthopaedics, Philadelphia, Pennsylvania
,
Fabio Orozco
3   Department of Orthopaedic Surgery, Rothman Institute of Orthopaedics, Philadelphia, Pennsylvania
,
Veronica Bennett
3   Department of Orthopaedic Surgery, Rothman Institute of Orthopaedics, Philadelphia, Pennsylvania
,
Zachary Post
3   Department of Orthopaedic Surgery, Rothman Institute of Orthopaedics, Philadelphia, Pennsylvania
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Abstract

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.

Keywords

kneeling - total knee arthroplasty - activities of daily living


Publication History

Received: 17 April 2019

Accepted: 14 October 2019

Article published online:
09 December 2019

© 2019. Thieme. All rights reserved.

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  • References

  • 1 Weinstein AM, Rome BN, Reichmann WM. et al. Estimating the burden of total knee replacement in the United States. J Bone Joint Surg Am 2013; 95 (05) 385-392
    CrossrefPubMedGoogle 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
    CrossrefPubMedGoogle 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 Dawson J, Fitzpatrick R, Murray D, Carr A. A response to issues raised in a recent paper concerning the Oxford knee score. Knee 2006; 13 (01) 66-68
    CrossrefPubMedGoogle Scholar
  • 5 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
  • 6 Wallace SJS, Berger RA. Most patients can kneel after total knee arthroplasty. J Arthroplasty 2019; 34 (05) 898-900
    CrossrefPubMedGoogle Scholar
  • 7 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
  • 8 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
  • 9 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
  • 10 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
  • 11 Smith JRA, Mathews JA, Osborne L, Bakewell Z, Williams JL. Why do patients not kneel after total knee replacement? Is neuropathic pain a contributing factor?. Knee 2019; 26 (02) 427-434
    CrossrefPubMedGoogle Scholar
  • 12 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
  • 13 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
  • 14 Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. National Joint Registry for England and Wales, Data from the National Joint Registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. J Bone Joint Surg Br 2007; 89 (07) 893-900
    CrossrefPubMedGoogle Scholar
  • 15 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
  • 16 Hassaballa M, Vale T, Weeg N, Hardy JR. Kneeling requirements and arthroplasty surgery. Knee 2002; 9 (04) 317-319
    CrossrefPubMedGoogle Scholar
  • 17 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
  • 18 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
  • 19 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
  • 20 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
  • 21 Amin RM, Vasan V, Oni JK. Kneeling after total knee arthroplasty. J Knee Surg 2020; 33 (02) 138-143
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 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