Does Kneeling Damage Knee Replacement?

Does the kneeling position damage the replacement?

No, the kneeling position does not damage the total or unicompartimental knee replacement.

Why do I say that? Here’s a list of reasons:

1. After almost 15 years of providing knee rehabilitation for individuals who have undergone knee surgery (recently or several years ago), I have never encountered a single person who experienced replacement issues after kneeling (except for possible transient pains).
2. I have known several individuals who resumed gardening or even classical dance after a total knee replacement. They were capable of squatting and kneeling, although it remains the exception.
3. I regularly read scientific publications on the aftermath of knee replacements (especially to enhance the website you are currently reading, Fonto Media), and I have never come across anything suggesting that kneeling is dangerous.
4. Some studies follow individuals for several years after knee surgery. The three most common reasons for knee replacement surgical revision (which remains a rare occurrence) are (Postler 2018):
   • Infection
   • Replacement loosening for reasons other than infection, typically after 15-20 years of replacement wear
   • Fracture (resulting from a fall)
5. There are several studies on kneeling after a knee replacement (link at the end of the article), and none report it as dangerous, forbidden, or deleterious.

Here are the statements from a research team on this matter:

“There is currently no clinical evidence to suggest that there is a medical reason why patients should not kneel on their prosthetic knee, and reasons not to do so could be addressed through education and rehabilitation.”

Wylde 2019

Therefore, after a certain period, you can attempt to kneel with your total knee replacement.

How long should you wait? That’s precisely what I will detail now.

How long before you can kneel?

You likely won’t be able to kneel for several weeks after the surgery. This is entirely normal as the knee is inflamed, stiff, painful, and swollen during this period.

With the help of your physical therapist and through self-rehabilitation, you will gradually improve your ability to bend the knee over the weeks.

Typically, at the follow-up appointment with your surgeon 4-8 weeks after the operation, you should be able to bend the knee to 90°, 100°, or even 110° or 120° for the fortunate ones.

It is at this point that, in my opinion, you can consider kneeling:

• because you will have had the follow-up appointment with your surgeon to ensure everything is fine,
• because you will likely have enough flexion to support the kneeling position. You need at least 90°, but ideally closer to 110/120° knee flexion to be able to kneel comfortably.

Consider kneeling at least 4-8 weeks after the operation when you have regained sufficient flexion.

How to kneel with a total knee replacement?

The first step is to regain sufficient flexibility in the knee.

Your physical therapist will have shown you exercises to help you recover knee flexion.

You can also read my article on how to reduce swelling and bend a stiff knee.

Once you have at least 90° of flexion without needing to force it, ideally closer to 110°, you can try kneeling.

The first few times, I recommend doing it:

• by leaning on something solid and low, like a sofa;
• by placing a gym mat on the floor for added comfort.

Which knee to put on the ground? It’s up to you, although it’s often easier to place the knee that was recently operated on the ground. So, the left knee if you were operated on the left.

Slowly descend while leaning on your arms placed on the sofa to put minimal pressure on the knees.

Once the knee is on the ground, you can place the other one next to it.

To get up, use your arms for support.

Initially, only stay in the kneeling position for about ten seconds.

Then gradually increase this time!

When you are comfortable with this approach, you can descend to the ground by leaning on one arm. Then, you won’t need support, or you can simply rely on one of your knees and the floor.

I demonstrate this in the video below!

Note: Studies report that there is no link between the flexibility or stiffness of the knee after the operation and the ability to kneel or not (Wylde 2019). I believe this applies only to individuals who have been operated on for several months.

Why kneeling is often uncomfortable?

Except for children, the kneeling position is not very comfortable, even under normal circumstances!

I have met many people who, without any particular pathology, already had a lot of difficulty kneeling, even without specific leg problems.

The total knee replacement alters the anatomical structure of your joint. The flexion of your knee is more limited than without a replacement. This makes the kneeling position less natural and less comfortable.

Moreover, you probably had previous traumas or arthritis in this knee, which motivated the placement of the replacement. Your knee is therefore “worn out” and less comfortable.

What to do if you can’t kneel?

First, know that you are NORMAL if you have difficulty kneelingafter the replacement: 60 to 80% of people who undergo total knee replacement report having difficulty doing so! (Wylde 2019)

These figures come from several studies including thousands of patients, even up to 5 years after the operation.

Many people undergoing knee surgery could no longer kneel BEFORE the operation (or did not have the opportunity).

From the sample of people who had total knee replacement rehabilitation (for this or another issue), I would say that about 5% were able to kneel.

If you can’t kneel:

• you are “normal,” and it does not mean there is an issue with the prosthesis;
• keep hope: some people continue to recover after the operation for months or even years. It is possible that you will be able to kneel in a few months;
• try to establish a routine by squatting, leaning on a sofa at least 2 or 3 times a week for 30-40 seconds. Over time, it is likely to become easier;
• although logic would suggest that having a more flexible knee allows for better kneeling, this is not verified by facts. Nevertheless, I believe that establishing a general routine of muscle and joint maintenance is a good thing to maximize the chances of being able to kneel with your prosthesis one day.