Why do patients not kneel after total knee replacement? Is neuropathic pain a contributing factor?

Johnny Mathews, James R A Smith, Zoe Bakewell, Lindsay Osborne, James Williams

Research output: Contribution to journalArticle (Academic Journal)peer-review

5 Citations (Scopus)


AIMS: Despite kneeling being an important and valued function of the knee, a proportion of patients are unable to kneel following arthroplasty. We explore the reasons for this, and assess whether neuropathic pain is a contributing factor.

METHODS: In this observational study, data was collected prospectively for 134 knees. At one year follow-up, patients completed a semi-structured questionnaire, the Oxford Knee Score (OKS), and the painDETECT score. Ability to kneel was assessed by question 7 of the OKS. Change in kneeling ability was assessed using Wilcoxon signed-rank test, normal data with independent t-test, and a regression and ANOVA analysis performed to assess predictors of kneeling ability.

RESULTS: 88% of patients had tried kneeling post-operatively. There was no change in kneeling ability for the whole cohort from pre- to post-operatively (p = 0.313). Patient reasons for not kneeling varied. Male gender, younger age and a reduced pain score were all significantly associated with a greater ability to kneel postoperatively. There was a trend towards an improved ability with increased flexion. Mean pain scores for all kneeling abilities lay within the nociceptive rather than neuropathic range.

CONCLUSION: Kneeling ability varies greatly post-knee replacement, and is multifactorial. Greater pain is a contributing factor to the inability to kneel postoperatively, but this appears to be nociceptive rather than neuropathic in nature.

Original languageEnglish
Pages (from-to)427-434
Number of pages8
Issue number2
Early online date13 Feb 2019
Publication statusPublished - Mar 2019

Bibliographical note

Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved.


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