A knee prosthesis can significantly improve the quality of life for people with chronic knee problems by alleviating pain and restoring mobility. However, kneeling poses a particular challenge with a knee prosthesis, which is especially relevant for working patients in physically demanding professions. In this article, we examine the most important aspects of kneeling after knee replacement surgery and discuss why it is often problematic with a total joint replacement. We also highlight why partial joint replacement, such as a sled prosthesis, offers better conditions here.

Why is kneeling with a knee prosthesis problematic?

Kneeling poses a challenge after knee replacement for several reasons:

Limitations due to prosthetic mechanics

A total knee replacement (total endoprosthesis, TEP) replaces the entire knee joint and alters the natural biomechanics of the knee. The prosthesis is made of metal components and a polyethylene insert, making the joint stiffer. This can limit mobility, especially flexion beyond 120 degrees, which is required for kneeling.

Pain and pressure sensitivity

Another factor is the pain or pressure sensation that patients experience when kneeling. The skin, underlying tissue, and the prosthesis itself are heavily stressed when kneeling, which can lead to discomfort or pain.

Psychological barriers and uncertainty

Many patients experience uncertainty when putting pressure on the knee. They fear damaging the prosthesis or provoking discomfort, which leads them to avoid kneeling from the outset.

Differences between total prosthesis and partial prosthesis

Total knee arthroplasty (TKA)

A total knee replacement replaces the entire knee joint. This is necessary when all three compartments of the knee - medial, lateral, and patellofemoral joints - are affected. While a TKR offers high pain reduction and improved mobility, extreme flexion positions such as kneeling are often severely limited. A complete restoration of natural mobility is not possible due to the prosthesis mechanics.

Sled prosthesis (partial prosthesis)

Unlike TEP, a unicompartmental knee arthroplasty replaces only a single compartment of the knee joint, usually the inner (medial) or outer (lateral) one. The natural biomechanics of the knee joint are largely preserved, allowing for better mobility. Studies show that patients with a unicompartmental knee arthroplasty are often better able to perform movements such as kneeling or squatting.

Effects on daily work routine with knee replacement

Requirements in physically demanding occupations

Physically demanding occupations – e.g., craftsmen, nursing staff, or floor layers – often require kneeling. With a total endoprosthesis, these patients often need to adjust their professional requirements. It is essential to be informed about these limitations before surgery.

Alternatives and Counseling

Partial joint replacement can be a suitable alternative for patients who want to remain physically active. However, here too, individual circumstances such as age, bone substance, and the extent of knee damage are crucial.

Kneeling with knee replacement - What does the evidence say?

Study situation on mobility after knee replacement

A meta-analysis of current studies shows that approximately 50-60% of patients after TEP have difficulty with movements such as kneeling or deep squatting. Patients with a unicompartmental knee replacement fare better: up to 80% report greater freedom of movement during flexion.

Long-term effects on quality of life

The limitations when kneeling can negatively impact quality of life, especially for patients with high occupational or personal demands on this movement. Early counseling and rehabilitation are crucial here.

Conclusion – Kneeling after knee replacement usually remains limited

Patients with a complete knee replacement must be prepared for the fact that kneeling is often no longer possible or is only possible with significant limitations. The mechanical properties of the prosthesis and the pressure sensation contribute significantly to these limitations.

For patients who place great value on the possibility of kneeling, a sled prosthesis can be a suitable alternative. It allows for greater freedom of movement and better maintains the natural biomechanics of the knee. Careful counseling before surgery and consistent rehabilitation are the keys to achieving the best possible outcome for each patient.