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Journal ArticleDOI

Patient Reported Kneeling Ability in Fixed and Mobile Bearing Knee Arthroplasty.

01 Dec 2015-Journal of Arthroplasty (Elsevier)-Vol. 30, Iss: 12, pp 2159-2163
TL;DR: Patients with fixed and mobile bearing UKA and TKA were able to kneel in the fixed compared to the mobile bearing groups up to two years after surgery indicating that self-reported kneeling ability is enhanced in fixedCompared to mobile bearing TKA.
Abstract: Kneeling is an important function of the knee joint required for many daily activities. Bearing type is thought to influence functional outcome following UKA and TKA. Self-reported kneeling ability was recorded in 471 UKA and 206 TKA patients with fixed or mobile bearing implants. Kneeling ability was recorded from the Oxford Knee Score question 7. The self-reported ability to kneel was similar in patients with fixed and mobile bearing UKA implants following surgery. In TKA, greater proportions of patients were able to kneel in the fixed compared to the mobile bearing groups up to two years after surgery indicating that self-reported kneeling ability is enhanced in fixed compared to mobile bearing TKA.

Summary (3 min read)

Introduction

  • Knee arthroplasty is a common procedure used to treat knee osteoarthritis.
  • Since 2003 almost 600,000 knee replacement procedures have been performed in England, Wales and Northern Ireland1, with 76,497 primary total knee arthroplasties (TKA) and 7,065 primary unicompartmental knee arthroplasties (UKA) performed in 2012 alone1.
  • Squatting and sitting crossed-legged2,3 Kneeling is an important function of the knee joint required for many normal activities and lifestyles and is indicative of a highly functioning knee2,3.
  • Recent reviews also suggest that mobile bearing TKA implants have no superiority in kneeling ability or functional outcomes over fixed bearing prostheses13,14.

Materials and Methods

  • Between 2000 and 2010, four hundred and seventy-one medial unicompartmental knee arthroplasties were performed in their unit.
  • Between 2001 and 2006, two-hundred and six total knee arthroplasties were performed as part of a prospective randomised controlled study.
  • All data was collected and stored on their knee group database which has been granted approval by the regional ethical committee (reference number 09/H0206/72).

Outcome measures

  • Self-reported kneeling ability was determined from question 7 of the Oxford Knee Score (OKS)15.
  • In addition, all patients completed the Western Ontario and McMaster Universities Arthritis Index 16.
  • Range of motion (ROM) was assessed using a universal Goniometer.
  • All data was collected preoperatively and at one, and two-years following surgery by an experienced research nurse or physiotherapist.

Unicompartmental Knee Arthroplasty

  • The Uniglide (Corin, Cirencester, UK) femoral component has a triple-radius femoral design made of cobalt chrome coated with titanium nitride.
  • The tibia has both fixed and mobile-bearing options.
  • The fixed-bearing component is a flat, ultra-high molecular-weight all polyethylene design with a stubby keel.
  • For all medial UKAs a limited medial parapatellar approach without patella dislocation was used.
  • There was a minor variation in surgical technique between a small sub-vastus or mid-vastus extension or complete quads sparing where possible.

Total Knee Arthroplasty

  • All TKAs were the Rotaglide+ prosthesis (Corin, Cirencester, UK).
  • Both mobile and fixed bearing options are compatible with a universal femoral component and tibial baseplate.
  • For the fixed bearing option, the specific bearing simply snaps into place on the same tibial baseplate17.
  • All TKA cases were done through a midline skin incision and a medial parapatellar approach.

Statistical Analysis

  • Descriptive statistics where used to calculate the proportion of scores recorded for the OKS question 7 for each mobile and fixed bearing knee arthroplasty.
  • TKA and UKA data were analysed separately when comparing kneeling ability of fixed and mobile bearing prostheses at each time point.
  • Pearson’s Chi-squared test was used to compare kneeling ability before and after surgery and between bearing types.
  • Significance was accepted at the 5% level.
  • IBM SPSS statistical software package version 21 was used to analyse the data.

Results

  • Kneeling ability and range of motion before and after surgery for both UKA and TKA are shown in Tables 1-4.
  • Proportions of scores recorded for the oxford knee score question 7 (kneeling ability) in fixed and mobile bearing UKA and TKA before surgery.
  • (0=no impossible, 1=with extreme difficulty, 2=moderate difficulty, 3=little difficulty, 4=yes).
  • Table 2. Proportions of scores recorded for the oxford knee score question 7 (kneeling ability) in fixed and mobile bearing UKA and TKA at one-year after surgery.
  • Proportions of scores recorded for the oxford knee score question 7 (kneeling ability) in fixed and mobile bearing UKA and TKA at two-years after surgery.

Pre-operative scores

  • Kneeling ability in patients awaiting a total knee replacement was poor with 49% of patients found it impossible to kneel down (Table 1).
  • No differences in the ability to kneel was observed between patients awaiting either a fixed or mobile bearing prosthesis (p=0.452).

Post-operative scores

  • A significant difference in kneeling ability was observed between mobile and fixed bearing groups at one (p=0.01) and two (p=0.002) years after surgery with a greater proportion of patients unable to kneel in the mobile group (Tables 2 and 3 respectively).
  • In the mobile bearing group, kneeling ability had significantly improved at one (p=0.017) and two (p=0.037) years after surgery.
  • Similar improvements were observed for kneeling ability in the fixed bearing group at both time points (p<0.001).
  • Correlation between kneeling ability, range of motion and WOMAC pain and function was similar to UKA with significant but poor correlation before surgery for WOMAC pain (p=0.003) and function (p<0.001) and significant moderate correlation at one and two years after surgery for all measures (p<0.001) (Table 5).

Discussion

  • The primary aim of this study was to compare the ability to kneel following knee arthroplasty between mobile and fixed bearing total and unicompartmental knee implants.
  • The results indicate that up to 2 years after surgery kneeling ability had improved in all groups with a higher proportion of patients finding it less difficult to kneel, but similar proportions of patients reporting kneeling as an impossible task.
  • The improvements observed were evident during the first post-operative year with little subsequent change over the following year.
  • Interestingly, patients with fixed bearing TKA reported a greater ability to kneel after surgery compared to those with a mobile bearing implant despite having a similar range of motion and WOMAC score.
  • The correlation between knee range of motion and self assessment of kneeling ability was poor following both UKA and TKA, indicating that factors other than range of motion influence whether patients can kneel or not.

Conclusion

  • The authors hypothesis was disproved; the ability to kneel appears to be independent of bearing type in UKA.
  • In TKA however, patients with fixed bearing prosthesis have a greater improvements in self-reported kneeling ability.
  • The direct relationship between kneeling ability, range of motion and patient reported measures of pain and function is questionable following both UKA and TKA indicating that many factors will contribute to whether patients are able to kneel.

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This is a peer-reviewed, post-print (nal draft post-refereeing) version of the following published
document and is licensed under Creative Commons: Attribution-No Derivative Works 4.0
license:
Artz, Neil ORCID: 0000-0003-1628-2439, Hassaballa, M,
Robinson, James R. and Newman, John H. (2015) Patient
Reported Kneeling Ability in Fixed and Mobile Bearing Knee
Arthroplasty. Journal of Arthroplasty, 30 (12). pp. 2159-2163.
doi:10.1016/j.arth.2015.06.063
O'cial URL: https://doi.org/10.1016/j.arth.2015.06.063
DOI: http://dx.doi.org/10.1016/j.arth.2015.06.063
EPrint URI: https://eprints.glos.ac.uk/id/eprint/8334
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PATIENT REPORTED KNEELING ABILITY IN FIXED AND MOBILE BEARING KNEE ARTHROPLASTY
Dr Neil Artz PhD
Mr Mo Hassaballa MD
Mr James Robinson MB BS MRCS FRCS(Orth) MS
Mr Andrew Porteous MBChB(UCT) DipPEC(SA) FRCS(Ed) MSc(Ortho Engin) FRCS(Tr & Ortho)
Mr James Murray MA FRCS (Tr and Orth) MB BChir (Cantab)
Abstract
Kneeling is an important function of the knee joint required for many daily activities. Bearing type is
thought to influence functional outcome following UKA and TKA. Self-reported kneeling ability
was recorded in 471 UKA and 206 TKA patients with fixed or mobile bearing implants. Kneeling
ability was recorded from the oxford knee score question 7. The self-reported ability to kneel was
similar in patients with fixed and mobile bearing UKA implants following surgery. In TKA, greater
proportions of patients were able to kneel in the fixed compared to the mobile bearing groups up to
two years after surgery indicating that self-reported kneeling ability is enhanced in fixed compared to
mobile bearing TKA.
Introduction
Knee arthroplasty is a common procedure used to treat knee osteoarthritis. Since 2003 almost
600,000 knee replacement procedures have been performed in England, Wales and Northern Ireland
1
,
with 76,497 primary total knee arthroplasties (TKA) and 7,065 primary unicompartmental knee
arthroplasties (UKA) performed in 2012 alone
1
. Reports from registry data indicate that
approximately 85% of patients are satisfied with their knee replacement and up to 90% describe
improvements in symptoms after surgery
1
. However, despite these high levels of symptomatic
improvement and satisfaction many patients continue to struggle with more challenging activities
that require high-flexion knee angles such as kneeling, squatting and sitting crossed-legged
2,3
Kneeling is an important function of the knee joint required for many normal activities and lifestyles
and is indicative of a highly functioning knee
2,3
. Several studies have shown that the ability to kneel
is not always possible after knee arthroplasty
2,4,5
. Consequently, functional limitations have been

shown during occupational, recreational, sporting and religious activities that can impact greatly
upon patient quality of life and satisfaction following knee arthroplasty
6,7
.
It is reported that although approximately 50% of patients undergoing knee arthroplasty consider the
post-operative ability to kneel as an important outcome, almost 80% will have limitations in their
kneeling ability
8
, and a recent study has indicated that with appropriate education and practice,
kneeling ability can be significantly improved after knee arthroplasty (UKA)
9
that may have a
beneficial impact on function and quality of life.
The ability to kneel also appears to be better in patients undergoing UKA compared to total knee
arthroplasty (TKA)
4
. Several studies have suggested that in both UKA and TKA, mobile bearing
implants restore kinematics closer to those of the native knee, yet despite this, none of the published
clinical series have demonstrated a significantly superior function
10-12
. Recent reviews also suggest
that mobile bearing TKA implants have no superiority in kneeling ability or functional outcomes
over fixed bearing prostheses
13,14
. However the literature comparing these different designs is scarce
and further investigation is warranted to determine whether mobile or fixed bearing implants provide
the best outcome after surgery, particularly with respect to highly demanding activities such as
kneeling.
With the limited information on kneeling ability after knee replacement in mobile and fixed bearing
knee arthroplasties, the primary aim of this study was to investigate mid-term kneeling ability in both
fixed and mobile bearing UKA and TKA prostheses. The secondary aim of this study was to
investigate the relationship between kneeling ability and measured knee motion, pain and function.
Our hypothesis was that mobile bearing implants (both total and unicompartmental) would confer
and advantage for patient kneeling ability.
Materials and Methods
Between 2000 and 2010, four hundred and seventy-one medial unicompartmental knee arthroplasties
were performed in our unit. The medial UKA group consisted of 205 mobile bearing knees (102
male, 103 female, with mean age 62.0 years) and 284 fixed bearing knees (158 male, 126 female,
with mean age 71.4 years). Between 2001 and 2006, two-hundred and six total knee arthroplasties
were performed as part of a prospective randomised controlled study. The TKA group consisted of
104 mobile bearing knees (47 male, 57 female, with a mean age of 61.7 years) and 102 fixed bearing
(54 male, 48 female, with a mean age of 61.6 years). All data was collected and stored on our knee

group database which has been granted approval by the regional ethical committee (reference
number 09/H0206/72).
Outcome measures
Self-reported kneeling ability was determined from question 7 of the Oxford Knee Score (OKS)
15
. In
addition, all patients completed the Western Ontario and McMaster Universities Arthritis Index
(WOMAC)
16
. Range of motion (ROM) was assessed using a universal Goniometer. All data was
collected preoperatively and at one, and two-years following surgery by an experienced research
nurse or physiotherapist.
Prostheses and Surgical Technique
Unicompartmental Knee Arthroplasty
The Uniglide (Corin, Cirencester, UK) femoral component has a triple-radius femoral design made
of cobalt chrome coated with titanium nitride. The tibia has both fixed and mobile-bearing options.
The fixed-bearing component is a flat, ultra-high molecular-weight all polyethylene design with a
stubby keel. The mobile-bearing option consists of a titanium nitride coated cobalt chrome tibial
component which has a flat articular surface with a medial flange that lies against the tibial
intercondylar eminence and an ultra-high molecular-weight polyethylene meniscal insert that is
unconstrained. For all medial UKAs a limited medial parapatellar approach without patella
dislocation was used. There was a minor variation in surgical technique between a small sub-vastus
or mid-vastus extension or complete quads sparing where possible.
Total Knee Arthroplasty
All TKAs were the Rotaglide+ prosthesis (Corin, Cirencester, UK). Both mobile and fixed bearing
options are compatible with a universal femoral component and tibial baseplate. For the fixed
bearing option, the specific bearing simply snaps into place on the same tibial baseplate
17
. All TKA
cases were done through a midline skin incision and a medial parapatellar approach.
Statistical Analysis
Descriptive statistics where used to calculate the proportion of scores recorded for the OKS question
7 for each mobile and fixed bearing knee arthroplasty. TKA and UKA data were analysed separately
when comparing kneeling ability of fixed and mobile bearing prostheses at each time point.
Pearson’s Chi-squared test was used to compare kneeling ability before and after surgery and

between bearing types. Kneeling ability was correlated with WOMAC pain and function scores using
Spearman’s rank correlation coefficient. Significance was accepted at the 5% level. IBM SPSS
statistical software package version 21 was used to analyse the data.
Results
Kneeling ability and range of motion before and after surgery for both UKA and TKA are shown in
Tables 1-4.
TABLE 1
Pre-
operative
Knees
Kneeling score (%)
0
1
2
3
4
UKA
Fixed
248
89 (36)
92 (37)
49 (20)
15 (6)
3 (1)
Mobile
223
70 (31)
85 (38)
56 (25)
9 (4)
3 (1)
All
471
159 (34)
177 (38)
105 (22)
24 (5)
6 (1)
TKA
Fixed
102
43 (42)
40 (39)
15 (15)
3 (3)
1 (1)
Mobile
104
58 (56)
36 (35)
7 (7)
3 (3)
0 (0)
ALL
206
101 (49)
76 (37)
22 (11)
6 (3)
1 (0)
Table 1. Proportions of scores recorded for the oxford knee score question 7 (kneeling ability) in fixed and mobile
bearing UKA and TKA before surgery. (0=no impossible, 1=with extreme difficulty, 2=moderate difficulty, 3=little
difficulty, 4=yes).
TABLE 2
1-year
post-op
Knees
Kneeling score (%)
0
1
2
3
4
UKA
Fixed
218
82 (38)
45 (21)
33 (15)
48 (22)
10 (5)
Mobile
219
69 (32)
53 (24)
45 (21)
38 (17)
14 (6)
All
437
151 (35)
98 (22)
78 (18)
86 (20)
24 (5)
TKA
Fixed
95
35 (37)
15 (16)
22 (23)
18 (19)
5 (5)
Mobile
101
52 (51)
22 (22)
15 (15)
11 (11)
1 (1)
ALL
196
87 (44)
37 (19)
37 (19)
29 (15)
6 (3)
Table 2. Proportions of scores recorded for the oxford knee score question 7 (kneeling ability) in fixed and mobile
bearing UKA and TKA at one-year after surgery. (0=no impossible, 1=with extreme difficulty, 2=moderate difficulty,
3=little difficulty, 4=yes).

Citations
More filters
Journal ArticleDOI
21 Feb 2019-BMJ
TL;DR: TKA and UKA are both viable options for the treatment of isolated unicompartmental osteoarthritis by directly comparing the two treatments, and this study demonstrates better results for UKA in several outcome domains.
Abstract: Objective To present a clear and comprehensive summary of the published data on unicompartmental knee replacement (UKA) or total knee replacement (TKA), comparing domains of outcome that have been shown to be important to patients and clinicians to allow informed decision making. Design Systematic review using data from randomised controlled trials, nationwide databases or joint registries, and large cohort studies. Data sources Medline, Embase, Cochrane Controlled Register of Trials (CENTRAL), and Clinical Trials.gov, searched between 1 January 1997 and 31 December 2018. Eligibility criteria for selecting studies Studies published in the past 20 years, comparing outcomes of primary UKA with TKA in adult patients. Studies were excluded if they involved fewer than 50 participants, or if translation into English was not available. Results 60 eligible studies were separated into three methodological groups: seven publications from six randomised controlled trials, 17 national joint registries and national database studies, and 36 cohort studies. Results for each domain of outcome varied depending on the level of data, and findings were not always significant. Analysis of the three groups of studies showed significantly shorter hospital stays after UKA than after TKA (−1.20 days (95% confidence interval −1.67 to −0.73), −1.43 (−1.53 to −1.33), and −1.73 (−2.30 to −1.16), respectively). There was no significant difference in pain, based on patient reported outcome measures (PROMs), but significantly better functional PROM scores for UKA than for TKA in both non-trial groups (standard mean difference −0.58 (−0.88 to −0.27) and −0.29 (−0.46 to −0.11), respectively). Regarding major complications, trials and cohort studies had non-significant results, but mortality after TKA was significantly higher in registry and large database studies (risk ratio 0.27 (0.16 to 0.45)), as were venous thromboembolic events (0.39 (0.27 to 0.57)) and major cardiac events (0.22 (0.06 to 0.86)). Early reoperation for any reason was higher after TKA than after UKA, but revision rates at five years remained higher for UKA in all three study groups (risk ratio 5.95 (1.29 to 27.59), 2.50 (1.77 to 3.54), and 3.13 (1.89 to 5.17), respectively). Conclusions TKA and UKA are both viable options for the treatment of isolated unicompartmental osteoarthritis. By directly comparing the two treatments, this study demonstrates better results for UKA in several outcome domains. However, the risk of revision surgery was lower for TKA. This information should be available to patients as part of the shared decision making process in choosing treatment options. Systematic review registration PROSPERO number CRD42018089972.

196 citations

Journal ArticleDOI
TL;DR: A review of the more recent literature available comparing FB and MB designs in biomechanical and clinical aspects concludes that the routine use of MB is not currently supported by adequate evidences; implant choice should be therefore made on the basis of other factors, including cost and surgeon experience.
Abstract: The mobile bearing (MB) concept in total knee arthroplasty (TKA) was developed as an alternative to fixed bearing (FB) implants in order to reduce wear and improve range of motion (ROM), especially focused on younger patients. Unfortunately, its theoretical advantages are still controversial. In this paper we exhibit a review of the more recent literature available comparing FB and MB designs in biomechanical and clinical aspects, including observational studies, clinical trials, national and international registries analyses, randomized controlled trials, meta-analyses and Cochrane reviews. Except for some minor aspects, none of the studies published so far has reported a significant improvement related to MBs regarding patient satisfaction, clinical, functional and radiological outcome or medium and long-term survivorship. Thus the presumed superiority of MBs over FBs appears largely inconsistent. The routine use of MB is not currently supported by adequate evidences; implant choice should be therefore made on the basis of other factors, including cost and surgeon experience.

32 citations


Cites background from "Patient Reported Kneeling Ability i..."

  • ...(22) surveyed FB and MB TKAs regarding kneeling ability, which is considered an important outcome by approximately 50% of patients....

    [...]

Journal ArticleDOI
TL;DR: Both the arthroplasty types provided satisfactory clinical results for patients with classic indications, however, MB-UKA tended to fail in early postoperative years whereas fixed-bearing UKA in later postoperatively years.
Abstract: Background Prior studies have compared fixed-bearing unicompartmental knee arthroplasty (FB-UKA) with mobile-bearing UKA (MB-UKA), suggesting that both procedures have good clinical outcomes. However, which treatment is more beneficial for patients is controversial. The purpose of our study is to evaluate the postoperative outcomes, including the revision rate, complications, functional results, range of motion, and femoral-tibial angle, between the 2 procedures. Methods We searched the MEDLINE, EMBASE, Cochrane Library, and Web of Science databases starting from August 2017 to May 2018. The publication date of articles was not restricted. Before we submit our contribution, we have re-searched it again. Articles that directly compared the postoperative outcomes of the 2 prosthesis type were included. Results A total of 15 comparative studies were included in our meta-analysis. The pooled data indicated no differences between the 2 operation modes in terms of revision rates, complications, and knee function, but earlier failure occurred more frequently with the MB design. Conclusion Both the arthroplasty types provided satisfactory clinical results for patients with classic indications. However, MB-UKA tended to fail in early postoperative years whereas fixed-bearing UKA in later postoperative years. Therefore treatment options should be carefully considered for each patient, and surgeons should still use their personal experience when deciding between these options.

23 citations

Journal ArticleDOI
Fei Huang1, Dan Wu1, Jun Chang1, Chi Zhang1, Kunpeng Qin1, Faxue Liao1, Zongsheng Yin1 
TL;DR: This meta-analysis has demonstrated that both prostheses provided excellent clinical outcomes and survivorship in patients with unicompartmental knee OA, and achieved the expected postoperative neutral limb alignment as compared with the FB UKA group.
Abstract: Many studies have compared mobile-bearing (MB) and fixed-bearing (FB) unicompartmental knee arthroplasties (UKAs) in patients with unicompartmental knee osteoarthritis (OA). The present systematic review and meta-analysis examined the differences in the clinical and radiological outcomes of MB UKA and FB UKA. PubMed, EMBASE, and Cochrane databases, as well as Google Scholar were searched for relevant studies. Randomized controlled trials (RCTs) and cohort studies that compared MB UKA and FB UKA were included. The weighted mean difference in the knee scores and range of motion (ROM) as well as the summary odds ratio of postoperative mechanical axis alignment, radiolucency, revision rate, and complications were calculated in the MB UKA and FB UKA groups. Finally, 2 RCTs and 11 cohort studies that involved 1,861 patients (1,996 knees) were included. The FB UKA group showed better postoperative Knee Society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and ROM than the MB UKA group. However, the MB UKA group had more knees with a neutral limb alignment and a lower incidence of polyethylene wear than the FB UKA group. No significant differences were observed between the groups with respect to radiolucency, revision rate, and complications, such as arthritis progression, aseptic loosening, and postoperative pain. This meta-analysis has demonstrated that both prostheses provided excellent clinical outcomes and survivorship in patients with unicompartmental knee OA. The MB UKA group achieved the expected postoperative neutral limb alignment as compared with the FB UKA group, while the FB UKA group showed higher knee scores and superior ROM than the MB UKA group. Limited evidence is currently available; therefore, the results of our meta-analysis should be interpreted with caution.

16 citations

Journal ArticleDOI
TL;DR: Numbness after knee replacement is common but is not associated with worse patient reported outcomes, and difficulty with kneeling did correlate with both self‐reported numbness and distress at numbness.
Abstract: INTRODUCTION Some patients report continuing pain and functional limitations after total knee replacement (TKR). While numbness around the TKR scar is common, the impact of numbness is less clear. One particular activity that could be influenced by numbness is kneeling. The aim of this study was to explore the impact of numbness around TKR scars on health related quality of life and kneeling ability. METHODS Fifty-six patients were recruited one year after primary TKR. Sensation around the knee was assessed through patient self-reporting, monofilament testing and vibration, and patients' distress was measured on a visual analogue scale. Patient reported outcome measures (PROMs) including the Western Ontario and McMaster Universities (WOMAC®) index, the Knee injury and Osteoarthritis Outcome Score (KOOS), the painDETECT® (Pfizer, Berlin, Germany) questionnaire and the EQ-5D™ (EuroQol, Rotterdam, Netherlands) questionnaire were used. Participants were also asked about kneeling ability. RESULTS While 68% of patients reported numbness around their TKR scar, there was no statistically significant correlation between numbness and distress at numbness (self-report: 0.23, p=0.08; monofilament: 0.15, p=0.27). Furthermore, numbness did not correlate significantly with joint specific PROMs (WOMAC®: 0.21, p=0.13; KOOS: 0.18, p=0.19). However, difficulty with kneeling did correlate with both self-reported numbness (0.36, p=0.020) and worse PROM scores (WOMAC® pain subscale: 0.62, p<0.001; KOOS: 0.64, p<0.001). CONCLUSIONS Numbness after knee replacement is common but is not associated with worse patient reported outcomes.

15 citations


Cites background from "Patient Reported Kneeling Ability i..."

  • ...Other studies have shown correlations between difficulty in kneeling and a reduced range of movement.(16,20,28) Despite this, our findings that numbness around TKR scars does not significantly correlate with distress or joint specific PROM scores and health related quality of life should allow clinicians to reassure patients about the impact of any numbness they may experience....

    [...]

References
More filters
Journal Article
TL;DR: WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials and fulfil conventional criteria for face, content and construct validity, reliability, responsiveness and relative efficiency.
Abstract: Within the context of a double blind randomized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs, we validated WOMAC, a new multidimensional, self-administered health status instrument for patients with osteoarthritis of the hip or knee. The pain, stiffness and physical function subscales fulfil conventional criteria for face, content and construct validity, reliability, responsiveness and relative efficiency. WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials.

7,147 citations


"Patient Reported Kneeling Ability i..." refers methods in this paper

  • ...ROM WOMAC Pain WOMAC Function TKA Pre 0.366 −0.211 −0.302 1-year 0.342 −0.505 −0.522 2-year 0.370 −0.528 −0.562 UKA Pre 0.100 −0.365 −0.422 1-year 0.047 −0.546 −0.571 2-year 0.189 −0.486 −0.551 n Fixed and Mobile Bearing Knee Arthroplasty, J Arthroplasty (2015), explored in this study but could be related either to intrinsic knee problems or to extrinsic factors [18] limiting this task performance....

    [...]

  • ...Correlations between self-reported kneeling ability and WOMAC measures of pain and function were R = −0.365 (P b 0.001) and R = −0.422 (P b 0.001) respectively indicating a significant but poor correlation before surgery (Table 3)....

    [...]

  • ...Pre-Op 1 Year 2 Year UKA Fixed 108.7 (15.4) 115.6 (12.0) 118.6 (23.6) Mobile 110.0 (14.0) 118.7 (14.9) 117.0 (14.7) TKA Fixed 99.9 (16.7) 104.4 (15.3) 104.3 (15.8) Mobile 100.2 (18.3) 103.8 (12.7) 105.1 (13.6) Please cite this article as: Artz NJ, et al, Patient Reported Kneeling Ability i http://dx.doi.org/10.1016/j.arth.2015.06.063 Correlation between kneeling ability, range of motion and WOMAC pain and function was similar to UKA with significant but poor correlation before surgery for WOMAC pain (P = 0.003) and function (P b 0.001) and significant moderate correlation at one and two years after surgery for all measures (P b 0.001) (Table 3)....

    [...]

  • ...Kneeling ability was correlated with WOMAC pain and function scores using Spearman’s rank correlation coefficient for ordinal data....

    [...]

  • ...Factors that influence kneeling ability were not Spearman’s Rank Correlation Coefficients (R) Between Kneeling Score (OKS question 7) and Range of Motion (ROM), WOMAC Pain and Function Score in TKA and UKA Before Surgery and at One and Two Years After Surgery....

    [...]

Journal ArticleDOI
TL;DR: In this article, a 12-item questionnaire for patients having a total knee replacement (TKR) was developed and a prospective study of 117 patients before operation and at follow-up six months later, asking them to complete the new questionnaire and the form SF36.
Abstract: We have developed a 12-item questionnaire for patients having a total knee replacement (TKR). We made a prospective study of 117 patients before operation and at follow-up six months later, asking them to complete the new questionnaire and the form SF36. Some also filled in the Stanford Health Assessment Questionnaire (HAQ). An orthopaedic surgeon completed the American Knee Society (AKS) clinical score. The single score derived from the new questionnaire had high internal consistency, and its reproducibility, examined by test-retest reliability, was found to be satisfactory. Its validity was established by obtaining significant correlations in the expected direction with the AKS scores and the relevant parts of the SF36 and HAQ. Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up. We also compared change in scores with the patients' retrospective judgement of change in their condition. The effect size for the new questionnaire compared favourably with those for the relevant parts of the SF36. The change scores for the new knee questionnaire were significantly greater (p < 0.0001) for patients who reported the most improvement in their condition. The new questionnaire provides a measure of outcome for TKR that is short, practical, reliable, valid and sensitive to clinically important changes over time.

2,177 citations

Journal Article
TL;DR: Patient expectations were important independent predictors of improved functional outcomes and satisfaction following TJA and greater understanding of the relationship between expectations and outcomes may improve the process of care and outcomes of TJA.
Abstract: OBJECTIVE: To evaluate the relationship between patient expectations of total joint arthroplasty (TJA) and health related quality of life plus satisfaction 6 months after surgery. Methods. This prospective cohort study included patients undergoing primary total hip (THA) and knee arthroplasty (TKA). Patients were evaluated with self-report questionnaires prior to surgery and 6 months post-surgery. Medical Outcomes Study Short Form 36 (SF-36), the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), and a satisfaction scale were used to evaluate outcomes at final followup. Multivariate regression models were used to evaluate the impact of expectations on outcomes. RESULTS: There were 102 patients with THA and 89 with TKA. Mean age was 66 years. All patients achieved significant improvements in their WOMAC and SF-36 scores following surgery. Patient expectations regarding surgery were not associated with their age, gender, index joint of surgery, marital status, or race. Expectations were not correlated with pre-operative functional health status. Expectation of complete pain relief after surgery was an independent predictor of better physical function and improvement in level of pain at 6 months post-surgery. Expectation of low risk of complications from TJA was an independent predictor of greater satisfaction. CONCLUSIONS: Patient expectations were important independent predictors of improved functional outcomes and satisfaction following TJA. Greater understanding of the relationship between expectations and outcomes may improve the process of care and outcomes of TJA.

590 citations


"Patient Reported Kneeling Ability i..." refers background in this paper

  • ...Relationships between ROM and function have been shown to be weak in knee osteoarthritis [24] and after knee arthroplasty [25], with predictive variables such as patient expectation [26] and pre-operative levels of function [27] indicative of post-operative outcome....

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Journal ArticleDOI
TL;DR: A high correlation between the importance of activities and frequency of patient participation confirming that knee replacement successfully restores a significant degree of function is shown, however, improvements in knee function still are needed to allow patients to do all activities that they consider important.
Abstract: There is interest in quantifying the patient's function and mobility after joint replacement. The current study identified activities important to patients having total knee replacement and the prevalence of limitations to participation in these activities. A Total Knee Function Questionnaire consisting of 55 questions addressing the patient's participation in various activities was developed, validated, and mailed to 367 patients at least 1 year after knee replacement. Patients were asked the frequency with which they did each activity, the activity's importance to them, and the extent to which their participation was limited by their knee replacement. The questionnaire was returned by 176 patients, 40% men and 60% women, with an average age of 70.5 years. The most prevalent activities were stretching exercises (73%), leg strengthening exercises (70%), kneeling (58%), and gardening (57%). The activities most important to the patients were stretching exercises (56%), kneeling (52%), and gardening (50%); those most difficult were squatting (75%), kneeling (72%), and gardening (54%). The current study showed a high correlation between the importance of activities and frequency of patient participation confirming that knee replacement successfully restores a significant degree of function. However, after knee replacement, improvements in knee function still are needed to allow patients to do all activities that they consider important.

368 citations

Journal ArticleDOI
TL;DR: Measurement of knee range of motion in a weight-bearing fashion may be a superior method of assessment of functional capabilities.
Abstract: Knee range of motion was determined in 60 patients to assess the effect of weight bearing on maximal knee flexion. Three patient subgroups were investigated: patients with normal knees, patients implanted with posterior cruciate-retaining (PCR) total knee arthroplasty (TKA), and patients implanted with posterior cruciate-substituting (PS) TKA. Maximal knee flexion was determined using videofluoroscopy both in a passive, non-weight-bearing mode and during active weight bearing. Flexion was diminished with weight bearing in all three subgroups (P < .045). Patients with normal knees exhibited significantly greater knee flexion than either TKA subgroup when measured either with or without weight bearing (P < .001). Knee flexion of both TKA subgroups was similar when measured passively without weight bearing. Patients with PS TKA demonstrated greater flexion than patients with PCR TKA when measured in weight bearing (P < .025), despite having less range of motion and lower clinical performance ratings preoperatively. Measurement of knee range of motion in a weight-bearing fashion may be a superior method of assessment of functional capabilities.

285 citations

Frequently Asked Questions (2)
Q1. What are the contributions in this paper?

The self-reported ability to kneel was similar in patients with fixed and mobile bearing UKA implants following surgery. In TKA, greater proportions of patients were able to kneel in the fixed compared to the mobile bearing groups up to two years after surgery indicating that self-reported kneeling ability is enhanced in fixed compared to mobile bearing TKA. 

Why some patients are able to kneel and others are not following UKA remains uncertain and requires further work to identify specific factors that might be amenable to new surgical techniques or therapeutic exercise. Future studies should look to include and compare such objective and subjective assessments of kneeling. The ability to kneel is thought to reflect high functional activity however their study suggests that this relationship is not necessarily the case. The authors suggest future randomised trials comparing fixed and mobile bearing UKA with the inclusion of objective and subject measures of functional tasks such as kneeling.