Arutiunian Z. Prevention and treatment of contractures after primary knee arthroplasty.

Endoprosthetic replacement is a very effective and common method of treatment of patients with severe abnormalities of the knee joints, but the problem of contractures in the postoperative period remains unresolved. The most effective method of treating patients with knee contractures after primary endoprosthetic replacement is kinesiotherapy. At the same time, the impact of rehabilitation on the structural and functional state of the operated knee joint and musculoskeletal system in general is one of the most poorly studied aspects of postoperative management of patients after total endoprosthetic replacement of the knee, and there is no evidence to support the effectiveness of previously known preoperative or postoperative rehabilitation measures. The purpose of the study was to increase the effectiveness of prevention and treatment of knee contractures after primary endoprosthetic replacement. The object of the study was knee contractures after primary endoprosthetic replacement. Methods of the study: clinical; radiological; biochemical; electromyographic; biomechanical; statistical. Diagnostic criteria for determining the probability of postoperative complications in the form of contractures after endoprosthetic replacement of the knee have been developed and used in practice. The effectiveness of the use of statography for the timely prevention of contractures after endoprosthetic replacement of the knee with determination of the necessary rehabilitation measures, as well as control of their results has been proved. An improved set of rehabilitation exercises for the prevention and treatment of patients with knee contractures after primary endoprosthetic replacement has increased the effectiveness of treatment of these patients by preventing the development of contractures by restoring and strengthening muscles and tendons that directly affect knee function, with emphasis on the load on quadriceps muscle of the thigh. Practical recommendations for prevention of development and treatment of contractures after primary endoprosthetic replacement of the knee have been elaborated. Scientific novelty of the obtained results: Electromyographic examination determined the condition of the flexor and extensor muscles of the knee joint after its primary endoprosthetic replacement, proved that the quadriceps of the thigh is the most important for the prevention and treatment of contracture. Biochemical studies identified markers (glycoproteins, chondroitin sulfates, alkaline phosphatase activity and ESR) indicating the possibility of contractures. Biomechanical studies revealed the features of the support and kinematic function of the lower extremity before and after primary endoprosthetic replacement of the knee in patients with contracture, as well as in volunteers with a fixed knee orthosis. The results of the dissertation have been introduced into clinical practice of the state institution “Professor M.I. Sytenko Institute of Spine and Joint Pathology of the National Academy of Medical Sciences of Ukraine”, 411 military clinical hospital (Military Medical Clinical Center of the Southern region), Kharkiv Regional Clinical Hospital, municipal non-profit enterprise “City Clinical Multidisciplinary Hospital No. 17” of Kharkiv City Council (17th City Clinical Multidisciplinary Hospital). Field of employment – medicine (traumatology and orthopedics).