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In Russia and globally, total knee arthroplasty (TKA) has been increasingly performed. The high quality of implants, improvement of arthroplasty technologies, and accumulated practical experiences of surgeons did not considerably reduce the frequency of complications and unsatisfactory operative outcomes. The negative consequences of knee replacement are determined both intraoperatively and postoperatively. This review aimed to analyze the literature on the frequency and complications of knee arthroplasty and their causes in the long-term postoperative period. In recent decades, the number of patients who are not satisfied with TKA outcomes has been increasing. Moreover, information about complications, their frequency, their causes, and possibilities of preventing negative consequences remains contradictory. Surgical treatment of complications requires particular attention, with surgical site infections as the most common. Recent studies highlight the important of evaluating surgical site infections during and after TKA, especially for deep infectious complications after TKA, which leads to hospitalizations, and reoperations. To date, many studies have investigated early postoperative complications leading to negative consequences in the long-term postoperative period. In addition, in the absence of postoperative complications, the service life of the implant is limited, and unsatisfactory TKA outcomes were attributed to wear and tear of the endoprosthesis. Domestic and international studies about premature or unreasonable TKA, as one of the reasons for negative osteoarthritis treatment outcomes, are increasing. The discussion about the indications and contraindications for knee arthroplasty continues. This literature review discusses the current state of this topic.

BACKGROUND: In recent years, in traumatology and orthopedics, statistical methods of survival analysis have been used to assess long-term treatment results, which make it possible to take into account censored clinical observations. This method of statistical analysis allows to take into account both cases of attrition from care and cases of incomplete follow-ups. There is no concurrent point of view on the dependence of the long-term results of hip and knee arthroplasty on the comorbidity of a patient. This circumstance fosters a special study using survival analysis. AIM: To study the long-term results of total hip and knee arthroplasty in the patients with osteoarthritis. To determine the patients quality of life depending on the presence of pronounced concomitant pathology. MATERIALS AND METHODS: The groups of patients with comorbidity and without significant concomitant pathology have been compared. The first group included 806 patients aged 19 to 88 years who underwent primary total hip replacement in the Clinic of Traumatology and Orthopedics of the North-Western State Medical University named after I.I. Mechnikov from 2014 to 2018 in connection with osteoarthritis. The second group consisted of 376 patients aged 43 to 85 years who underwent primary total KR due to osteoarthritis in the V.A. Baranov Republican Hospital (Petrozavodsk) in 20162019. Statistical data processing and graph design have been carried out with R programming language with open access via https://cran.r-project.org. The probability of maintaining a satisfactory assessment of the quality of life by a certain observation point t (year of observation) has been assessed using the KaplanMayer method. The logrank test has been used in order to compare the probability of maintaining a satisfactory assessment of quality of life during the entire follow-up period in the groups of patients with and without polymorbidity. RESULTS: At the end of the 5th year of follow-up, the probability of maintaining excellent and good quality of life after hip replacement with a 95% confidence interval was 0.88 (0.81; 0.94) in the patients without comorbidity, 0.84 (0.79; 0.88) in the patients with severe concomitant pathology. Test statistics (Z = 0.93) and p = 0.31 indicate statistically insignificant differences in survival curves between the groups of patients with varying degrees of comorbidity. When analyzing the five-year results of the knee replacement, the quality of life among patients with high and low comorbidity did not differ significantly. The probability of excellent and good quality of life at the 5th year of follow-up in practically healthy patients and in cases of mild therapeutic disease was 0.78 (0.67; 0.88); with a high degree of comorbidity 0.74 (0.65; 0.81). CONCLUSIONS: By the end of the 5th year of follow-up of the patients who have undergone hip or knee replacement due to osteoarthritis, an excellent and good quality of life can be expected on average in 80% of the patients. Satisfactory and unsatisfactory in 20% of the patients. Excellent and good quality of life 5 years after hip or knee arthroplasty in the patients with severe comorbidity does not significantly differ from that in the practically healthy patients without comorbidity (р 0,05).

Introduction Total knee arthroplasty is the treatment of choice in orthopedic practice for patients with late stage knee osteoarthritis. However, arthroplasty has not only benefit results and the service life of the endoprothesis is limited. The use of modern conservative therapy and joint-preserving surgions allowed to delay or to avoid knee arthroplasty. Purpose. The study purpose is the analysis of publications with negative results of knee arthroplasty in patients with knee osteoarthritis. Materials and methods. The electronic Pub-Med/MEDLINE and eLibrary databases were searched for reviews published between 2002 and 2022. A keyword search was also done using the terms: knee joint osteoarthritis, total knee replacement/arthroplasty, complications, patient satisfaction, indications/contraindications for surgery; related definitions and descriptions were extracted. Results. The negative consequences of total knee arthroplasty are heterogeneous. Complications can be local and systemic such as surgical site infection, periprosthetic fracture, aseptic loosening (asepticinstability) of theendoprosthesis and its wearand the implant failure. The researchers data indicate increasing the number of patients who are not satisfied with the results of arthroplasty both in the short term and in the long-term after the operation, due to the natural wear of the prosthesis. Patients are not satisfied with the results of the operation 8% -30%. In recent years, there have been more publications devoted to the limitation of indication for arthroplasty in pftients with knee osteoarthritis. The replacement of the knee joint with an implant was done unreasonably in great number of cases.A number of patients after total knee arthroplasty require revision surgery within the first 5 years. Currently, the risk of failure of knee arthroplasty with the revision surgery in 10 years after primary arthroplasty is 5-6.8%. The main reasons for revision surgery after primary knee arthroplasty are periprosthetic infection and instability of the implant components, while the results of revision surgery are worse than the primary arthroplasty.