A Comparison of Kneeling Ability After Lateral or Midline Incisions In Total Knee Arthroplasty

Patients will be randomised to receive either a midline skin incision or a lateral skin incision. All patients will undergo total knee arthroplasty via a medial parapatellar approach. Total knee arthroplasty will take from 60 to 90 minutes, surgical duration, across all groups. Within the group of treating surgeons there will also be a distribution of patients receiving a total knee arthroplasty via navigated and non-navigated techniques, and receiving cruciate retaining or cruciate sacrificing knee replacements as per the surgeons’ preferred practice. These will not be specifically controlled for in the randomisation process as they are unlikely to affect kneeling tolerance and doing so will limit the external validity of the trial. Randomisation will be stratified based on patella resurfacing or no patella resurfacing, as this may impact kneeling tolerance. Adherence to the randomisation schedule will be monitored by audit of the operation notes. Post-operatively, all participants will undergo routine rehabilitation for total knee arthroplasty, involving full weight bearing and early active range of movement. Post-operative analgesia will consist of paracetamol and non-steroidal anti-inflammatories, with opioids for breakthrough pain as per routine clinical treatment.