Specific surgical tactics features for the prevention of unsatisfactory total knee arthroplasty outcomes

Abstract

The objective of the study was to improve the treatment results of patients with total knee arthroplasty (TKA) by substantiating and developing differentiated surgical tactics. The study included 151 patients (212 cases) who underwent TKA without patella replacement. The patients were divided into two groups: the main group is 74 patients (110 cases) and the comparison group is 77 patients (112 cases). In the main group, surgery was performed by using the developed installing tactics. The comparison group included the patients after the traditional surgical technique described in the manuals. There was no statistically significant difference between the groups (p = 0.52). The treatment results were assessed in 3, 6, 12, 24 months and more after surgery. KSS (Knee Society Score) and Kujala scales were used. The tactics of surgical intervention was developed, consisting of the correct installation of femoral and tibial components and capsular-ligamentous balancing of the patellofemoral joint. After the components implantation, the capsular-ligamentous balancing of the patellofemoral joint was performed depending on the patella position relative to the block of the femoral component (tilt, subluxation or dislocation of the patella). 5 types of patellar tendon extension were used: release of the lateral patellofemoral ligament, mobilization of the lateral skin flap from the capsule, “grid” type release, iliotibial tract release. The developed surgical tactics for TKA allowed us to obtain the better immediate and long-term treatment results than the traditional surgical technique. During the femoral and tibial component implantation, it is especially important to take into account the points that are directly related to the biomechanics of the patellofemoral part of the knee joint.