Abstract
Background
The ability to kneel plays a crucial role in the daily events of nearly every individual's life, affecting occupational and domestic activities, which are, at times, closely intertwined with cultural and religious customs. The lack of literature addressing the patients concerns regarding the capacity, to which they will be able to function post-operatively, motivated us to investigate this issue further, so as to be able to more comfortably and precisely convey the answer to this question pre-operatively.
Material and Methods
In this cross-sectional longitudinal study, all patients were evaluated for eligibility, with prerequisites including those having had total knee arthroplasty (TKA) secondary to a pre-operative diagnosis of osteoarthritis of the knee, from the years 2007–2010 at Poursina Trauma Center, Rasht, Iran. All procedures using a midline skin incision followed by medial parapatellar arthrotomy without re-surfacing of the patella. A PCL substituting prosthesis was chosen for implant. Demographic Data, Knee Society Score (KSS), Functional Knee Score (FKS), Visual Analog Scale (VAS), and patient kneeling ability, were all extracted and recorded, pre-operatively, 1-year post-operative, and again during final follow-up. Statistical analysis was interpreted using SPSS software version 19.
Results
Of 114 cases, 69 were female (60.5%), 45 were male (39.5%), with a mean age of 67.9 ± 6.2 years (52 to 81) and mean follow-up range of 26.7 ± 2.4 months (14 to 44). VAS before surgery was 9.24 ± 0.7, which was significantly higher than those taken at 1-year follow-up, 1.82 ± 1.04, and at final follow-up, 2.01 ± 1.19. KSS and FKS values were significantly higher at both 1-year and long-term follow-up than those taken before surgery (p<0.0001). Before knee replacement 76 patients (66.7%) could not kneel, out of which 59 patients (77.6%) reported this inability because of reasons relating to the knee, while the remaining 17 patients (22.4%) reported their inability was due to non-knee associated factors. On long-term follow-up of the 59 patients whose inability to kneel was associated with issues relating to the knee, 42 patients (71.2%) found it possible to kneel again without pain or discomfort, or with mild discomfort only(see figure 1). It is clear after analyzing the data of patients who have received TKA, with regards to pre-surgical kneeling ability versus this ability months and years later, there is a statistically significant positive relationship between TKA and regaining the ability to kneel (p<0.0001).
Conclusion
It seems that after total knee replacement in patients affected by osteoarthritis of the knee, the resultant decreased pain and increased function in knee flexion leads to strengthening of kneeling ability.
