title: Factors preventing kneeling in a group of pre-educated patients post total knee arthroplasty.
abstract: BACKGROUND
  Difficulties in kneeling, one of the poorest scoring functional outcomes post total knee arthroplasty (TKA),have been attributed to a lack of patient education. This is the first study to investigate specific factors affecting a patient's perceived ability to kneel post TKA, following exposure to a preoperative kneeling education session.
  
  
  METHODS
  A cross-sectional study was conducted following TKA with patients who had been educated about kneeling prior to the operation. Patients completed kneeling questionnaires at 6 (n = 115) and 12 (n = 82) months post TKA. In addition to the 12-month kneeling questionnaire, patients also completed the Oxford knee score (OKS) survey.
  
  
  RESULTS
  Seventy-two percent of patients perceived they could kneel at 12 months post TKA. Overall, pain and discomfort were the most common factors deterring patients from kneeling. Perceived kneeling ability was the poorest scored outcome on the OKS with patients reporting mild to moderate difficulty with this task. Kneeling scores were strongly correlated with overall knee function scores (R = 0.70), strongly correlated with pain scores (R = 0.45) and weakly correlated with knee stability scores (R = 0.29). When asked about other factors preventing kneeling other than pain or discomfort, 75 % had reasons unrelated to the knee or TKA. The most common reason was 'problems with the other knee' (n = 19).
  
  
  CONCLUSIONS
  Patients in this study were provided with education regarding their kneeling ability post TKA, yet still experienced limitations in perceived kneeling ability postoperatively. Contrary to previous research, our study suggests that factors other than patient education affect a patient's perceived kneeling ability post TKA.
authors.affiliation: Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia. lw844@uowmail.edu.au.
authors.forename: Leigh
authors.initials: L
authors.lastname: White
authors.affiliation: Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Stockwell
authors.affiliation: Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Hartnell
authors.affiliation: Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Hennessy
authors.affiliation: Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Mullan
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D051346:Mobility Limitation; D020370:Osteoarthritis, Knee / Q000601:surgery; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D011184:Postoperative Period; D011187:Posture / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology*; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Kneeling; Patient education; Total knee arthroplasty