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In the name of GOD

In the name of GOD. Kneeling ability after total knee replacement in patients with osteoarthritis of the knee. M. Mardani Kivi MD. Guilan University of Medical Sciences. Rasht. Kish Island. Poursina Hospital. Osteoarthritis.

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In the name of GOD

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  1. In the name of GOD

  2. Kneeling ability after total knee replacement in patients with osteoarthritis of the knee M. Mardani Kivi MD. Guilan University of Medical Sciences

  3. Rasht Kish Island

  4. Poursina Hospital

  5. Osteoarthritis • 40% of the population over 70 years of age suffers from osteoarthritis of the knee and by the year 2020this figure is expected to rise by 66-100%.

  6. Total Knee Arthroplasty • over 500,000 TKAs being performed, on average, in the United States annually.

  7. Total Knee Arthroplasty • In 2001, 171,335 primary TKAs were performed. • Demand for primary TKA is projected to grow in the USA to 3.48 million procedures by 2030. • By 2015, medical expenses for this procedure in the United States are calculated to increase to a staggering $40.8 billion.

  8. Kneeling

  9. Kneeling • Most of the functional scoring systems quoted in literature use pain, the ability to walk or to ascend and descend stairs, the use of a walking aid, etc. as measurements of outcome. The ability to kneel is often ignored.

  10. Aim of the Study • The lack of literature addressing the specific concerns of a large percentage of our Iranian patients with their particular cultural habits, regarding the capacity to which they will be able to kneel post-operatively, has motivated us to investigate: “kneeling ability after TKA in patients with OA of the knee.”

  11. Methods and Materials:

  12. Methods and Materials:

  13. Variables were assessed 3 times: pre-op, one year post-op, and during the final follow-up visit.

  14. Kneeling

  15. Kneeling

  16. Post-op Rehabilitation • Post operatively along with Physiotherapy, which included a special program for knee flexion, patients were also encouraged to kneel vigorously and frequently.

  17. Group A and B were analyzed for changes in kneeling ability.

  18. Results: • Total patient population:144114 were possible to follow-up • Mean age: 67.9±6.2 years (range:52 to 81) • Sex: 69 female (60.5%), 45 male (39.5%) • Mean follow-up length: 26.7±2.4 months (Range:14 to 44)

  19. Scoring:

  20. Kneeling results: Pre-op Post-op

  21. Complications:

  22. Discussion: • Similar to other studies, Our study showed a statistically significant improvement in functional outcome (KSS, FKS) and pain relief (VAS) after TKA. • Ahmad Hafiz et al, 2011 • Tahmasebi et al, 2009 • Dierick et al, 2004

  23. Factors affecting kneeling after TKA:

  24. Kneeling and prosthesis type • A meta-analysis using results from 130 studies: • Although more recent studies have shown data to be more in favor of PCL substituting prostheses.

  25. Kneeling and surgical technique

  26. Kneeling and cultural differences: • Yoshino et al. : The ‘unintentional’ passive flexion exercise imparted by the Japanese sitting-style appears to be important in achieving and maintaining full knee flexion after TKA. • In Iran: eating traditionally on the ground and praying

  27. Kneeling and misinformation: • No study has supported that kneeling repetitively may damage knee prostheses. • Palmer et al. (2002)

  28. Kneeling and misinformation: • Radiographic study has shown that forces exerted from the femur to knee joint:

  29. Kneeling and misinformation: • Schai et al. and Palmer et al. showed that kneeling ability, when measured objectively, is greater than when measured subjectively after TKA.

  30. Kneeling and misinformation: • Jenkins et al. (2008) a single-blind randomized controlled trial The improvement in patient-reported kneeling ability was thought to be due to the kneeling interventionprovided and not to any of the previously reported barriers to kneeling such as scar position, numbness, range of flexion, involvement of other joints, and pain.

  31. Radiographic Shopping • A 68 Y/O Female • DJD

  32. Radiographic Shopping

  33. Radiographic Shopping

  34. Take home message: • There is no need to prohibit patients from Kneeling after Total Knee Replacement.

  35. With Regards

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