A knee replacement can significantly improve the quality of life for people with chronic knee problems by relieving pain and restoring mobility. However, kneeling after knee replacement surgery presents a particular challenge, especially for working patients in physically demanding jobs. This article examines the key aspects of kneeling after knee replacement surgery and explains why it is often problematic with a total knee replacement. We also explore why a partial knee replacement, such as a unicompartmental knee replacement, offers better conditions in this regard.

Why is kneeling problematic with a knee prosthesis?

Kneeling after knee replacement surgery presents a challenge for several reasons:

Limitations due to the prosthesis mechanics

A total knee replacement (TKR) replaces the entire knee joint and alters the natural biomechanics of the knee. The prosthesis is made of metal components and a polyethylene insert, which makes the joint stiffer. This can restrict movement – ​​especially flexion beyond 120 degrees, which is necessary for kneeling.

Pain and pressure sensitivity

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

Psychological barriers and uncertainty

Many patients feel insecure when they put pressure on their knee. They fear damaging the prosthesis or causing discomfort, which leads them to avoid kneeling altogether.

Differences between full dentures and partial dentures

Total endoprosthesis (TEP)

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

Partial knee replacement (sliding prosthesis)

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

Impact on daily work life with a knee prosthesis

Requirements in physical professions

Physically demanding professions – such as tradespeople, nurses, or floor layers – often require kneeling. With a total knee replacement, these patients often have to adjust their work requirements. It is important to be informed about these limitations before the operation.

Alternatives and advice

Partial joint replacement can be a suitable alternative for patients who wish to remain physically active. However, individual factors such as age, bone density, and the extent of knee damage are crucial.

Kneeling with a knee prosthesis - What does the evidence say?

Current research on mobility after knee replacement

A meta-analysis of current studies shows that approximately 50–60% of patients experience difficulties with movements such as kneeling or deep squatting after a total knee replacement (TKR). Patients with a partial knee replacement fare better in this regard: up to 80% report greater freedom of movement during flexion movements.

Long-term effects on quality of life

Limitations in kneeling can negatively impact quality of life, especially for patients with high professional or personal demands on this movement. Early consultation and rehabilitation are crucial in these cases.

Conclusion – Kneeling after knee replacement usually remains limited

Patients with a total knee replacement must be prepared for the fact that kneeling is often no longer possible or 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 ability to kneel, a partial knee replacement can be a suitable alternative. It allows for greater freedom of movement and better preserves the natural biomechanics of the knee. Thorough pre-operative consultation and consistent rehabilitation are key to achieving the best possible outcome for each patient.