Ways to achieve natural kinematics during total knee replacement

Relevance. Being a fairly successful operation knee replacement does not always meet the expectations of patients. Significant parts of them have restrictions on some important types of daily activities. Increasing the degree of satisfaction determines the relevance of this publication.

The aim of the study. To improve patient satisfaction rates after knee replacement by recreating natural biomechanics.

Materials and methods. The hypothesis of the importance of surgical access and surgical techniques for restoring function formed the basis of the study. The study included 164 patients with grade III-IV Kellgren-Lawrence osteoarthritis who underwent total knee replacement with cruciate retaining implant (Triathlon). All patients were divided into two clinical groups. The first group included 85 patients (51.8%) who underwent TKA with a traditional mechanical alignment technique. The second group consisted of 79 patients (48.2%) who underwent surgery according to the protocol we developed, which included the principles of kinematic alignment and the technique of arthroplasty while preserving the extensor apparatus and ligament attachment sites. We conducted a comparative assessment of the postoperative functional results of various knee arthroplasty techniques.

Results. The analysis of the results on the OKS, WOMAK, and KSS scales determined superior indicators in the main group, especially in the early stages of postoperative follow-up. Although with an increase in the period of postoperative follow-up, the advantage of the main group of patients according to traditional scales was gradually lost. However, the FJS-12 scale significantly showed greater satisfaction in the main group.

Conclusion. Restoration of the natural biomechanics of the knee joint is the key to patient satisfaction after arthroplasty. The basis of this reconstruction is the preservation of the kinematic axes of knee joint movements and the normal relationships of soft-tissue structures.

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