Kneeling ability after total knee arthroplasty. Perception and reality

Kneeling as one of the knee's capabilities required for many activities of daily living has not been examined in detail after total knee replacement. The purpose of the present study was to question the patients' ability to kneel and their perception of factors affecting this ability after total knee arthroplasty, and to objectively assess their kneeling ability. Seventy patients with 100 total knee arthroplasties were asked to comment on their ability to kneel. Thirty-one patients with 44 knees said they could kneel easily, 29 patients with 41 knees said they were able to kneel but avoided doing so, and 10 patients with 15 knees said they were unable to kneel. Regarding observed kneeling ability, all patients were able to kneel under supervision: 56 patients with 82 knees knelt easily and got up easily from this position, 11 patients with 14 knees showed slight difficulties in kneeling or in getting up, and three patients with four knees had marked difficulties with kneeling. The patients' perceived ability to kneel after total knee arthroplasty was less than their observed ability. Fear of harming the prosthesis and lack of information prevented kneeling in 49% of the patients (27 of 56 knees) with perceived inability to kneel. Of those patients with observed difficulty in kneeling, scar pain and back related problems seemed to be major factors in limiting the kneeling ability. Kneeling, as an important function of the knee, should be given additional consideration in relation to the functional results of total knee arthroplasty. Patients should be counseled regarding factors affecting future ability to kneel.