Kneeling After Total Knee Arthroplasty: Does Resurfacing the Patella Affect the Ability to Kneel?

Abstract

Difficulty and pain with kneeling is a common postoperative complaint after total knee arthroplasty (TKA), but the cause of this issue has not been identified. The purpose of this study was to investigate the effect of patella resurfacing on a patient's kneeling ability after TKA with consideration of the preoperative presence of patellar osteoarthritis (P-OA). This was a single-center study of patients who underwent TKA at least one year prior to survey administration. Patellar resurfacing was routinely performed in the presence of patellar arthritis; whether to resurface a patella without arthritis was based on surgeon judgment. Patients were surveyed on pre- and postoperative ability to kneel and satisfaction with ability to kneel, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement was collected preoperatively and with survey distribution. There were 132 knees in the no P-OA, unresurfaced group; 110 in the P-OA, resurfaced group; and 121 in the no P-OA, resurfaced group. Pre- and postoperative KOOS-JR were equivalent across groups. All cohorts reported worsening of their kneeling ability after TKA with no differences in reported difficulty in kneeling across cohorts. Patients who did not have resurfaced patellae reported non-significantly lower mean pain scores for kneeling on different surfaces. With respect to their ability to kneel postoperatively, patients in all groups were more likely to report being very satisfied or satisfied, but patients who did not have P-OA were more likely to be dissatisfied or very dissatisfied if their patellae were resurfaced (P = 0.045). Patients who did not have preoperative P-OA that underwent patella resurfacing reported greater dissatisfaction with kneeling postoperatively than patients who had unresurfaced patellae. Despite patients reporting worsening of their ability to kneel postoperatively regardless of preoperative P-OA presence or use of patella resurfacing, patient satisfaction with their kneeling ability remained high.