Beyond the Surgical Factors: Preoperative Habits, Cutaneous Sensation, and Adaptive Strategies as Predictors of Kneeling Ability Following Total Knee Arthroplasty.

BACKGROUND: Kneeling is consistently the poorest patient-reported outcome after TKA. While previous studies have examined surgical variables as predictors of kneeling ability following TKA, a discrepancy between patients' perceived and observed ability to kneel suggests that kneeling behavior is influenced heavily by psychological or contextual factors. The primary objective of this study was to evaluate several non-surgical factors as predictors of kneeling ability following TKA.

METHODS: Patients who underwent primary TKA between May 1, 2021, and April 30, 2024, were included. There were 165 patients who were successfully contacted for administration by telephone of a novel patient-reported questionnaire that assessed pre- and post-surgical kneeling frequency and exercise regularity, activity-based need for kneeling, adaptations to kneeling strategy, and cutaneous patellar sensation. Statistical analyses were conducted to identify relationships between variables.

RESULTS: Greater exercise activity before surgery was associated with higher frequency of kneeling both pre- (P < 0.001) and post-surgery (P < 0.001). Higher perceived importance of kneeling was associated with higher frequency of kneeling both pre-surgery (P < 0.001) and post-surgery (P < 0.001). Those who indicated kneeling for leisure activities were more likely to employ adaptations to their kneeling strategy and to report a higher frequency of kneeling post-surgery (P < 0.001). Greater reported severity of abnormal sensation on the patellar region was associated with greater reported impact on kneeling (P < 0.001). Hypersensitivity and burning or shock-like sensations were associated with lower frequency of kneeling post-surgery (P = 0.046 and P = 0.035, respectively), while numbness and hypersensitivity were associated with an established habit of avoiding kneeling (P = 0.017).

CONCLUSIONS: Our results suggest that kneeling outcomes following TKA may be influenced by patients' pre-surgical exercise and kneeling behavior. Activity-specific motivation and greater perceived importance of kneeling were associated with behavioral self-management and improved functional outcome. Also, we found that varying superficial sensory changes on the patellar region demonstrated distinct associations with kneeling-related behaviors.