In the name of GOD

1
In the name of GOD
2
Kneeling ability after total knee replacement in
patients with osteoarthritis of the knee

• M. Mardani Kivi MD.
• Guilan University of Medical Sciences

3
Rasht
Kish Island
4
Poursina Hospital
5
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.

6
Total Knee Arthroplasty

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

7
Total Knee Arthroplasty

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

8
Kneeling
9
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.

10
Aim of the Study

• The lack of literature addressing the specific
  concerns of a large percentage of our Iranian
  patients with their particular cultural habits,
  regarding the capacity to which they will be able
  to kneel post-operatively, has motivated us to
  investigate kneeling ability after TKA in
  patients with OA of the knee.

11
Methods and Materials
12
Methods and Materials
13
Variables were assessed 3 times pre-op, one year
post-op, and during the final follow-up visit.
14
Kneeling
15
Kneeling
16
Post-op Rehabilitation

• Post operatively along with Physiotherapy, which
  included a special program for knee flexion,
  patients were also encouraged to kneel vigorously
  and frequently.

17

• Group A and B were analyzed for changes in
  kneeling ability.

18
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)

19
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
20
Kneeling results
Pre-op
Post-op
21
Complications
22
Discussion

• Similar to other studies, Our study showed a
  statistically significant improvement in
  functional outcome (KSS, FKS) and pain relief
  (VAS) after TKA.
• Ahmad Hafiz et al, 2011
• Tahmasebi et al, 2009
• Dierick et al, 2004

23
Factors affecting kneeling after TKA
24
Kneeling and prosthesis type

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

25
Kneeling and surgical technique
26
Kneeling and cultural differences

• Yoshino 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

27
Kneeling and misinformation

• No study has supported that kneeling repetitively
  may damage knee prostheses.
• Palmer et al. (2002)

28
Kneeling and misinformation

• Radiographic study has shown that forces exerted
  from the femur to knee joint

29
Kneeling and misinformation

• Schai et al. and Palmer et al. showed that
  kneeling ability, when measured objectively, is
  greater than when measured subjectively after
  TKA.

30
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.

31
Radiographic Shopping

• A 68 Y/O Female
• DJD

32
Radiographic Shopping
33
Radiographic Shopping
34
(No Transcript)
35
(No Transcript)
36
Take home message

• There is no need to prohibit patients from
  Kneeling after Total Knee Replacement.

37
With Regards