Golovakha M. Diagnostics, conservative treatment and reconstructive-restorative surgery of knee osteoarthritis.

The object of the investigation is knee joint osteoarthritis in the early stages of the disease. The purpose is the improvement of the results of treatment in patients with knee joint osteoarthritis through the development of a new system of treatment based on individual characteristics of the knee joint structure, clinical signs of the disease and injury criteria for arthroscopic articular cartilage. The methods used in this investigation are clinical, radiological, biomechanical, mathematical modeling, statistical ones. The research of the influence of the initial state of the knee joint on the treatment result of the damaged articular cartilage against the background of gonarthrosis has been carried out and it has first been proved that it depends on individual particularities of the joint, and the area of the defect of the articular cartilage has no considerable influence on the treatment result. It has been shown that the occurrence of subchondral swell of bone tissue on MR-scan of patients with gonarthrosis indicates the beginning of its progression. Biomechanical correction has been suggested in order to redistribute the load in the knee joint due to the usage of valgus inner soles. The use of early load on the operated extremity after operations on the articular cartilage and high correcting osteotomy of the tibia is given scientific proof. The significance of the angulation of plateau of the tibia in sagittal plane for the risk of damage of anterior crucial ligament has first been demonstrated. It has been proved that the change of the angle leads to the change of frontal stability of ligamentous apparatus of the knee joint and to the displacement of the zone of loading on condylus thibiae. The possibility of the use of high correcting osteotomy of the tibia with the change of the angulation of condylies in sagittal plane when treating complex instability of the knee joint against the background of osteoarthrosis has first been proved. Differentiated selection of indications to high opening correcting osteotomy of the tibia and to monocondillar endoprosthesis replacement in the presence of gonarthrosis with predominant affection of its medial part has been grounded. The health services were given new efficient methods of conservative and open surgical treatment of osteoarthrosis of the knee joint. The suggested scale for the prediction of the results of microfracturization and mosaic plastic surgery of cartilage defects as well as the algorithm of differentiated treatment for patients with osteoarthrosis of the knee joint have given the possibility to select a method of treatment and to ensure high specific weight of successful treatment results. The implement of new methods of physiofunctional treatment with early knee load after being operated on for the articular cartilage repair and high correcting osteotomy of the tibia allowed to reduce the terms of functional recovery for the extremity.The results of research have been implemented in clinical practice: KU "Zaporozhye Regional Clinical Hospital"; KZOZ BRR "Balakleya Central Clinical Hospital" Kharkov region, Kyiv City Clinical Hospital № 3; Ukrainian State Scientific-Research Institute of Medical and Social Expertise, Dnepropetrovsk ; Lvov regional hospital for invalids of war and repressions; Hospital "Feofania" Public Administration in Kiev, Мedical unit of JSC "Motor Sich", Zaporozhye, Lugansk Regional Hospital; KZ "Kharkiv Regional Clinical Hospital of traumatology"; Department of Orthopedics and Microsurgery Transcarpathian Regional Hospital, Donetsk Regional Trauma Hospital. Traumatology and orthopaedy.