Background: Total knee arthroplasty (TKA) is an effective management option to improve pain and quality of life for end-state osteoarthritis [1]. Despite its benefits, one in five patients remain dissatisfied with the outcome of the surgery, especially regarding kneeling ability [2]. Kneeling is an important function in Asian cultures during dining, social participation, daily life occupations and religious practices, and patients rate it highly important to be able to do after TKA surgery [3].

Objectives: To investigate the patients’ profiles regarding the condition of the knee after surgery, the ability of kneel, the presence of pain during kneeling, and the fear of damage to the artificial joint in patients after TKA.

Methods: Ninety-one patients (mean age: 69,57±6,5; mean BMI: 32,22±5,12; 71,4% with unilateral TKA, 28,6% with bilateral TKA) with primary TKA were included in the study. A custom-made survey was used to assess patients, questioning the current condition of the knee compared to before surgery; ability to kneel, sit cross-legged, sit low; presence of pain during kneeling; and the thought that kneeling can damage the artificial joint if kneeled.

Results: 81,1% of the patients reported that the knee condition was better compared to before surgery, 13,9% reported as same before surgery, and 5,1% reported worse. 41,8% of patients were not able to kneel, 46,2% were able to kneel partially (i.e., upright kneeling, single-stance kneeling), and 12,1% were able to kneel fully. Sitting cross-legged was impossible for 66,3% of the patients, and 8,8% were able to sit cross-legged fully. Sitting low was possible for 53,5% of the patients and impossible for 2,2%. 63,7% of the patients reported having pain during or trying to kneel. Lastly, 89,4% of the patients reported that kneeling can damage the artificial joint if kneeled.

Conclusion: According to the results of this study, although patients are satisfied with the condition of their knees compared to before surgery, very few of them can kneel fully or sit cross-legged. However, sitting low was not a problem for half of the patients, which requires a high range of knee flexion like kneeling. The motivation to undergo surgery is to get rid of pain and have a better functional status, but there seems to be a fear factor for kneeling to avoid damaging the artificial joint. This avoidance might result from a lack of education and information for the patient after surgery or cause the patient to fear preventing the joint in the early stages of the post-op period. Among all, patients reported pain during kneeling or trying. These results show the importance of post-op rehabilitation to improve function and decrease pain, and the importance of patient education to prevent fear and avoidance to provide satisfaction after TKA surgeries.

REFERENCES: [1] Shah OA, Spence C, Kader D, Clement ND, Asopa V, Sochart DH. Patellar resurfacing and kneeling ability after total knee arthroplasty: a systematic review. Arthroplasty. 2023 Jun 3;5(1):32. doi: 10.1186/s42836-023-00184-5. PMID: 37268994; PMCID: PMC10238242.

[2] Scott CEH, Howie CR, MacDonald D, Biant LC. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010;92(9):1253–8

[3] Amin RM, Vasan V, Oni JK. Kneeling after Total Knee Arthroplasty. J Knee Surg. 2020 Feb;33(2):138-143. doi: 10.1055/s-0038-1676801. Epub 2019 Jan 2. PMID: 30602194.

Acknowledgements: NIL.

Disclosure of Interests: None declared.