Background: Total Knee Arthroplasty (TKA) is a prevalent surgical procedure for treating severe knee arthritis, aiming to alleviate pain and restore function. Recent advancements have introduced computer-assisted (CAS) and robot-assisted (RA-TKA) surgical techniques as alternatives to conventional methods, promising improved accuracy and patient outcomes. However, comprehensive comparative studies evaluating the short-term outcomes and prostheses survivorship among these techniques are limited. We hypothesized that the outcome of RA-TKA and/or CAS- TKA is advantageous in function and prosthesis survivorship compared to manually implanted prostheses. Methods: This prospective controlled study compared the short-term outcomes and prostheses survivorship following TKA using conventional, CAS, and RA-TKA techniques. One hundred seventy-eight patients requiring TKA were randomly assigned to one of the three surgical groups. The primary outcomes were knee function (KSS knee score) and functional recovery (KSS function score), which were assessed before surgery three years postoperatively. Secondary outcomes included prosthesis alignment, knee range of movements, and complication rates. Survivorship analysis was conducted using Kaplan–Meier curves, with revision surgery as the endpoint. Results: While all three groups showed significant improvements in knee function postoperatively (p < 0.001), the CAS and RA-TKA groups demonstrated superior prosthetic alignment and higher survivorship rates than the conventional group (100%, 97%, and 96%, respectively). However, although the RA-TKA group had a maximal 100% survivorship rate, its knee score was significantly lower than following CAS and conventional techniques (mean 91 ± 3SD vs. mean 93 ± 3SD, p = 0.011). Conclusion: The RA-TKA technique offers advantages over conventional and CAS methods regarding alignment accuracy and short-term survivorship of TKA prostheses. Since short-term prosthesis survivorship indicates the foreseen rates of mid- and long-term survivorship, the current data have a promising indication of the improved TKA prosthesis’s long-term survivorship by implementing RA-TKA. According to the presented data, although the survival rates were 100%, 97%, and 96% in the three study groups, no clinical difference in the functional outcome was found despite the better mechanical alignment and higher survivorship in the group of patients treated by the RA-TKA.

Osteoarthritis is a degenerative disease that affects articular cartilage, leading to changes on the macro and micro levels of this multi-component tissue. Understanding the processes underlying this pathology plays an important role in planning the following management tactics. Timely detection of the knee joint degradation at the level of tissue changes can prevent its progressive damage due to the early beginning of appropriate treatment. This study aimed to provide an overview of the current level of knowledge about the composition of cartilage and menisci using a wide range of different diagnostic methods. A systematic review of the literature published from 1978 to 2023 was conducted. Original studies of the knee joint cartilage (articular and meniscus) research, reporting content composition and mechanical properties, were included. Studies of the non-knee joint cartilage, tissue research other than cartilage and meniscus, or reporting treatment outcomes were excluded (n = 111). Thirty-one papers were included in this review, which reported on the composition of animal and human cartilage (articular and meniscus). The most frequently investigated parameters were quantitative proteoglycan determination and hydration level of the cartilage. Cartilage and meniscus degeneration, i.e., reduced collagen and proteoglycan content, reduced mechanical properties, and increased hydration level, was shown in every article about osteoarthritis. Among all diagnostic methods, laboratory methods (biochemical and histological analysis) are the most frequently used, compared to the instrumental ones (spectroscopy, MRI, and CT). At the same time, spectroscopy takes the lead and becomes the most common approach for determining cartilage composition (collagen and proteoglycans content). Graphical Abstract

BACKGROUND: Knee and hip joints endoprosthetics are the main surgical method of arthrosis treatment. The epidemiological incidence rate of the disease is growing steadily every year, affecting younger and younger people. Despite the proven tactics of joint endoprosthetics, an important issue is quality planning of surgery. AIM: The aim of this research is to develop a device and a method that would contribute to solving the existing challenges of pre-surgery planning of hip endoprosthetics in patients with related pathologies, which have caused compensatory deformation, and making long vertebrarium-pelvis-lower limbs scout images with the patient lying on his back with an axial load in a computer tomography. METHODS: Analog X-ray photographs of the pelvis made on film, digital DICOM images, and special planning programs are used for planning. However, according to numerous studies, the disease of the hip joint is not an independently isolated pathology. In most cases, this pathology is accompanied by changes in the lumbar spine. Often, patients prepared for endoprosthetics have a congenital deformity of tarsus or hip segment, which, during the knee, joint endoprosthetics surgery causes difficulties with the installation of an intramedullary guide. RESULTS: The results after total knee arthroplasty according to the method modified at the Department showed a reduction of the WOMAC index slightly more than twice down to 37.26 ± 7.92. The number of revision surgeries after endoprosthetics decreased from 5 (5.7%) to 1 (1.1%) for the hip joint, and from 7 (4.3%) to 2 (1.3%) for the knee joint, respectively. CONCLUSION: To form a proper guide entry point, it is necessary to assess the segment at the stage of surgery planning and examination of patients, which can be done using the proposed method. To remove the complications during the pre-surgery planning of hip joint endoprosthetics in patients with related pathologies, a device and methods have been developed for obtaining long topograms of the vertebrarium-pelvis-lower limbs complex with the patient lying on his back with the axial load in computer tomography.

ЦЕЛЬ ИССЛЕДОВАНИЯ Провести анализ результатов хирургического удаления грыж грудных межпозвонковых дисков из трансторакального экстраплеврального доступа. МАТЕРИАЛ И МЕТОДЫ В исследование включено 16 пациентов с 18 симптомными грыжами грудных межпозвонковых дисков, оперированных с использованием трансторакального экстраплеврального доступа. В 11 случаях клиническая картина заболевания представлена миелопатией наряду с корешковым или аксиальным болевым синдромом, в 5 — изолированной радикулопатией. Срединная локализация грыж наблюдалась в 8 (44,4%) случаях, парамедианная — в 10 (55,6%). Оссифицированных грыж было 10 (55,6%), гигантских — 5 (27,7%), больших — 10 (55,5%), средних — 3 (16,6%). РЕЗУЛЬТАТЫ У большинства пациентов интенсивность боли по визуальной аналоговой шкале (ВАШ) снизилась на 2—6 баллов (в среднем — 3,6), у 4 осталась прежней. Из 11 больных с миелопатией регресс проводниковых расстройств через 1 год после операции достигнут у 9 (82%) человек, у 6 (55%) из них наблюдалось полное восстановление (Frankel E, Nurick — 0—I). У 2 пациентов неврологический статус остался на дооперационном уровне. Во всех случаях при контрольном обследовании подтверждено полное удаление компримирующего субстрата и не выявлены признаки нестабильности оперированных сегментов позвоночника. Длительность операций варьировала от 80 до 210 мин (в среднем —161 мин). Объем кровопотери составил от 300 до 800 мл (в среднем — 378 мл). У 2 больных наблюдалось транзиторное усугубление неврологического дефицита. В 4 случаях имело место повреждение твердой мозговой оболочки. Межреберная невралгия наблюдалась у 3 пациентов. ЗАКЛЮЧЕНИЕ Сохраняя преимущества открытой торакотомии, трансторакальный экстраплевральный доступ менее травматичен, позволяет произвести полноценную декомпрессию спинного мозга, минимизировать риск ятрогенного повреждения спинного мозга и избежать ряда послеоперационных осложнений.

Objective. To evaluate the effectiveness and safety of skip corpectomy in surgical treatment of cervical spondylotic myelopathy. Material and methods. The study included 7 patients with cervical myelopathy following extended cervical spine stenosis. All patients underwent skip corpectomy. Clinical examination included degree of neurological disorders according to the modified scale of the Japanese Orthopedic Association (JOA) with assessment of recovery rate and Nurick score, as well as VAS score of pain syndrome. Verification of diagnosis was based on the data of spondylography, magnetic resonance and computed tomography. The indications for surgical treatment were conduction disorders and their spondylotic genesis confirmed by neuroimaging methods. Results. VAS score of pain syndrome decreased by 2—4 points (mean 3.1) in long-term postoperative period. The JOA, Nurick scores and recovery rate (mean 42.5%) demonstrated significant improvement of neurological status in all patients. In all cases, the follow-up examination confirmed adequate decompression and spinal fusion. Conclusion. Skip corpectomy provides adequate spinal cord decompression in case of extended cervical spine stenosis and minimizes the risk of complications typical for multilevel corpectomy. Recovery rate indicates the effectiveness of this method in surgical treatment of cervical myelopathy caused by multilevel stenosis. However, further studies on sufficient clinical material are needed.