In the name of GOD

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In the name of GOD
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Kneeling ability after total knee replacement in
patients with osteoarthritis of the knee

• M. Mardani Kivi
• Guilan University of Medical Sciences

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Osteoarthritis

• 40 of the population over 70 years of age
  suffers from osteoarthritis of the knee and by
  the year 2020 this figure is expected to rise by
  66-100.

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Treatment
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Total Knee Arthroplasty

• over 500,000 TKA being performed, on average, in
  the United States annually.

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Total Knee Arthroplasty

• In 2001, 171,335 primary TKA were performed.
• By 2015, medical expenses for this procedure in
  the United States are calculated to increase to a
  staggering 40.8 billion.
• Demand for primary TKA is projected to grow in
  the USA by 673 to 3.48 million procedures by
  2030.

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Kneeling
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Kneeling

• Most of the functional scoring systems quoted in
  literature use pain, the ability to walk or to
  ascend and descend stairs, the use of a walking
  aid, etc as measurements of outcome. The ability
  to kneel is often ignored.

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Aim of the Study

• The lack of literature addressing the specific
  concerns of a large percentage of our patients
  with OA undergoing TKA, regarding the capacity to
  which they will be able to function
  post-operatively performing these tasks, has
  motivated us to investigate kneeling ability
  after TKA in patients with OA of the knee.

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Methods and Materials
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Methods and Materials
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(No Transcript)
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• Group A and B were analyzed for changes in
  kneeling ability.

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Results

• Total patient population144?114 were possible to
  follow-up
• Mean age 67.96.2 years (range52 to 81)
• Sex 69 female (60.5), 45 male (39.5)
• Mean follow-up length 26.72.4 months (Range14
  to 44)

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Scoring
Score Pre-op 1-year f/up Final f/up P-value
VAS 9.24 0.7 1.82 1.04 2.01 1.19 plt0.0001
KSS 59.79 4.54 89.07 5.63 89.82 5.11 plt0.0001
FKS 59.57 4.48 87.72 5.21 88.23 5.36 plt0.0001
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Kneeling results
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Complications
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Discussion

• With the help of different measurement scales
  criteria (VAS, KSS, FKS), Our study showed a
  statistically significant improvement in
  functional outcome after TKA.
• Similar to other studies
• Ahmad Hafiz et al, 2011
• Tahmasebi et al, 2009
• Dierick et al, 2004

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Factors affecting kneeling after TKA
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Kneeling and prosthesis

• A meta-analysis using results from 130 studies
• Although more recent studies have shown data to
  be more in favor of PCL substituting prostheses.

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Kneeling and surgical technique
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Kneeling and cultural differences

• Shoji et al. The unintentional passive ?exion
  exercise imparted by the Japanese sitting-style
  appears to be important in achieving and
  maintaining full knee ?exion after TKA.
• In Iran eating traditionally on the ground and
  praying

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Kneeling and misinformation

• No study to date has supported that patients will
  do harm to their prostheses by kneeling
  repetitively.
• Hamai et al. (2008)
• Palmer et al. (2002)

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Kneeling and misinformation

• Radiographic studies have shown that forces
  exerted from the femur to knee joint

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Kneeling and misinformation

• The most recent studies showed that kneeling
  ability, when measured objectively, is greater
  than when measured subjectively after TKA.

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Kneeling and misinformation

• Jenkins et al. (2008) a single-blind randomized
  controlled trial? The improvement in
  patient-reported kneeling ability was thought to
  be due to the kneeling intervention provided and
  not to any of the previously reported barriers to
  kneeling such as scar position, numbness, range
  of ?exion, involvement of other joints, and pain.

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With Regards