The role of kneeling ability on post-operative outcomes in total knee arthroplasty

Total knee arthroplasty (TKA) is a widely performed surgery with high satisfaction rates; however, only a minority of patients reported being able to kneel postoperatively. Kneeling is essential in various daily and cultural activities, yet its determinants remain unclear.

This study aimed to compare functional outcomes, patient-reported outcome measures (PROMs), self-perceived knee condition, and fear of damaging the prosthesis between patients who can and cannot kneel after TKA.

A prospective cross-sectional study was conducted with 59 TKA patients aged 50-75 years. Participants were grouped based on their self-reported kneeling ability. Outcomes included isometric flexor and extensor knee strength, range of motion (ROM), 2-minute walk test, 5-times sit-to-stand test, and PROMs including the Oxford Knee Score (OKS), Forgotten Joint Score (FJS), and Tampa Scale for Kinesiophobia (TSK). Perceptions of knee condition and fear of prosthesis damage were assessed via a custom survey.

Patients able to kneel had significantly greater knee flexion ROM (p=0.013), higher flexor muscle strength (p=0.027), better performance in sit-to-stand (p=0.031), and higher OKS scores (p<0.01). No differences were found in extensor strength, FJS, TSK, or perception of knee condition and fear of prosthesis damage (p>0.05).

Kneeling ability after TKA is associated with better functional outcomes, yet perceptions of the knee and fear of damage remain similar across groups. Tailored rehabilitation and education addressing both physical and psychological barriers may improve postoperative kneeling outcomes.