If you’re due to undergo a total knee replacement, you may be wondering what you will and won’t be able to do following your surgery. As orthopaedic surgeons, we endeavour to understand our patients’ expectations and to help people to have a realistic idea of what they will be able to do following joint replacement surgery. We refer to these abilities as patient-reported outcome measures (or PROMS).
Who is offered a total knee replacement?
You may be offered a total knee replacement to replace a damaged or diseased knee joint if you have a degenerative condition like osteoarthritis or a severe knee injury. A total knee replacement involves replacing both sides of your knee joint whereas with a partial knee replacement only one side of the joint is replaced.
Kneeling after a total knee replacement
The ability to kneel after a total knee replacement is one of those areas where, sadly, surgical outcomes may not live up to patient expectations. There can be a number of different reasons for why patients find it hard to kneel after surgery, including pain or discomfort in the knee, anxiety about damaging the prosthesis or comorbidities which make it difficult to achieve a kneeling posture. It is surprisingly common to need to be able to kneel, from performing certain types of household tasks to getting up after a fall or even participating in certain leisure, social or cultural activities, so this can be a drawback for patients.
Edinburgh study
In a recent study, a team from The Royal Infirmary of Edinburgh set out to investigate whether patients could kneel after a total knee replacement without patellar resurfacing. They also looked at which kneeling positions were most important to patients.
The study involved 209 patients who had undergone single radius cruciate-retaining total knee replacement surgery without patellar resurfacing. Prior to surgery, researchers assessed the patients’ ability to achieve four types of kneeling positions – single-leg kneel, two-legged kneeling, high-flex kneeling or praying position. They also graded the severity of each patient’s osteoarthritis. After surgery, patients in the study – which included 151 with an average age of 70 years – completed the standard Oxford Knee Score, EuroQol five-dimension questionnaire and Kujala scores.
Findings
The researchers found that following a total knee replacement, the ability to kneel in the four positions outlined above improved in 19-35% of patients. However, 23-30% of patients experienced a decline in their ability to kneel. Single-leg kneeling was most important to patients, however, 41% of patients were unable to achieve a single-leg kneel after surgery. A similar number – 40% – were unable to achieve a praying position. Half of patients were unable to achieve a double-leg kneel, but the highest number (68%) was those patients who were unable to achieve a high-flexion kneel.
What this study shows is that, even though an ability to kneel is cited as an important outcome measure by many patients, sadly there are no guarantees that this will be achieved after surgery. In fact, it is equally likely that patients may experience a decline in the ability to kneel following a total knee replacement.
Talk to your surgeon
If you are due to undergo joint replacement surgery, it is important to discuss your expectations with your orthopaedic surgeon. It may be that, in some cases, other factors may affect your ability to kneel – such as concerns about damaging the prosthetic implant – in which case your surgeon should be able to put your mind at rest or suggest ways to kneel more comfortably.
Understanding the likely outcomes of your joint replacement surgery will help you to make an informed decision about whether or not to proceed and help you to manage your expectations. While total knee replacement surgery is a routine and highly effective procedure that can improve quality of life, it may not always be able to restore full knee function and it is important to understand this.
