Analysis of the results of applying a new approach to the prehabilitation of patients with total knee replacement

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INTRODUCTION

Total knee arthroplasty (TKA) belongs to some of the most significant achievements of the XX century orthopedics. At the same time, the frequency of surgeries for the knee arthroplasty is growing from year to year, which is related both to scientific advancements in the area of knee joint implants and the increase of surgeons’ qualifications, and to the growing number of patients in need of such surgeries [1, 2].

One of the most frequent indications for the TKA is the ostheoarthritis of the knee (OA) of stages III–IV according to the classification of Kellgren & Lawrence with a manifested pain syndrome and significant deterioration of the affected joint function. According to the Global Burden of Disease, OA of the knee affects approx. 595 million people in the world; according to the specialists’ opinion, the number of patients with this condition will significantly increase by 2050 [3, 4].

Total knee arthroplasty is to provide fast pain management, restoration of biomechanics of the affected joint and postoperative household and professional rehabilitation of patients within a short term. At the same time, it follows from scientific literature that 15 to 25% patients are not satisfied with the results of TKA because they continue experiencing pain, discomfort and limited mobility in the operated joint even in the event of proper positioning of the components of the prosthetic and lack of signs of their instability [5, 6].

One of the most important factors accounting for this situation in the functional deficiency of periarticular structures that correlates with the degree of severity of the destructive and dystrophic damage of the joint in the preoperative period expressed in the disorder of the dynamic gait stereotype, formation of contractures, development of chronic periarticular tendinitis and ligamentitis in the pre- and postoperative periods [7].

In the recent years, orthopedic traumatologists, physical and rehabilitation care doctors have been focusing more and more on prehabilitation, a complex of treatment activities aimed at preoperative correction of clinical and functional disorders of the lower extremities and improvement of the patient’s functional reserved before the surgery. The development and the use of treatment complexes of prehabilitation, and the study of its influence on the results of surgical treatment of TKA patients is becoming a very important field in the area of joint arthroplasty [8].

As of today, there have been published several foreign systematic reviews and meta-analyses integrating the data on the effect of prehabilitation on the outcomes of surgical treatment of patients after the TKA. They all demonstrate with conviction that prehabilitation assists earlier postoperative activation and verticalization, decrease of risk of complications, faster rehabilitation and decrease of hospital stay. One of the key conclusions consistently confirmed in the analyzed systematic reviews is the positive effect of prehabilitation in the early postoperative restoration of the function of the knee joint. This is manifested in improved metrics of the muscular strength of the quadriceps muscle of thigh, gait speed and ability of independent movement in the first weeks and months after the operation [9, 10].

An important aspect that often becomes the object of a separate analysis is the effect of prehabilitation in the pain syndrome and intake of analgesics. Postoperative pain is one of the main factors slowing down the patient’s activization and increasing the risk of complications. Studies in this area show the results that are not as decisive but generally positive: a decrease of manifestation of the pain syndrome after the surgery [11, 12].

The application of multimodal prehabilitation programs is of special interest. Apart from kinesiotherapy and physical therapy, these include diet therapy, psychological counseling and educational components [13].

Another important practical aspect addressed in specialized literature is the identification of optimal duration, intensity and combination of prehabilitation methods. Despite the extensive data available in foreign sources demonstrating the positive effect of prehabilitation, it still remains to be determined whether or not there exists a significant correlation between administration of prehabilitation and improvement of clinical condition, functional performance of the operated extremity and quality of life of patients after the TKA [14].

The most effective combination of techniques and the duration of prehabilitation also remain to be clarified; moreover, the existing methods of prehabilitation do not account for individual parameters of the patients and the phenotype of the identified osteoarthritis of the knee joint, which reduces the efficiency of prehabilitation activities [15, 16].

In the Russian literature, this problem received insufficient coverage, which is confirmed by a modest number of publications on the prehabilitation stage before large joint arthroplasty of the lower extremities [17].

In view of the above, the development and implementation of a new approach to prehabilitation in the clinical practice in the total knee arthroplasty including a prehabilitation complex in the knee joint arthroplasty¹ and the software product “Program for the Determination of a Customized Prehabilitation Complex for Total Knee Arthroplasty”² are important prospective tasks of the present-day traumatology and orthopedics.

AIM

To analyze the results of applying a new approach to the prehabilitation of patients with total knee arthroplasty (TKA).

MATERIAL AND METHODS

The study design was a prospective single-group clinical study. It included 33 patients with knee joint osteoarthritis of stages III and IV according to Kellgren & Lawrence. Before TKA, these patients underwent a prehabilitation complex designed by us. Prehabilitation and surgical treatment of all patients were performed from 2023 to 2025 on the basis of the Traumatology and Orthopedics Department No. 2 and Complex Rehabilitation Center of the Clinics of the Samara State Medical University of the Ministry of Health of Russia.

Inclusion criteria: sex – any; age – 18 to 70 years; verified osteoarthritis of the knee joint, stage III and IV according to Kellgren & Lawrence and verified osteoarthritis of the knee joint of the contralateral extremity, stage I and II according to Kellgren & Lawrence; intramalleolar distance ≤ 8 cm (for valgus deformity); intercondylar distance ≤ 8 cm (for varus deformity); shortening of the lower extremity ≤ 2 cm; BMI ≤ 35 kg/m2; daily life activity index (Barthel index) > 65 points; no acute and/or decompensation phase of the respective chronic infectious and non-infectious diseases; no history of non-drug treatment such as therapeutic exercising or physical therapy less than 3 months before the start of prehabilitation; no history of drug treatment by para- and intraarticular administration of cartilage protectors, hyaluronic acid, glucocorticosteroids, platelet-rich plasma (PRP), autologous stromal-vascular fraction (ASVF) and autologous red bone marrow cells (ARBM) administered less than one month before the start of prehabilitation; no history of surgeries on the affected knee joint or history of trauma indicating the secondary character of osteoarthritis.

Exclusion criteria: age below 18 or over 70 years; shortening of the lower extremity > 2 cm; intramalleolar distance > 8 cm (valgus deformity); intercondylar distance > 8 cm (varus deformity); history of non-drug treatment such as therapeutic exercising or physical therapy less than 3 months before the start of prehabilitation; history of drug treatment by para- and intraarticular administration of cartilage protectors, hyaluronic acid, glucocorticosteroids, PRP, ASVF and ARBM cells administered less than one month before the start of prehabilitation; history of surgeries on the affected knee joint or history of trauma indicating the secondary character of osteoarthritis; daily life activity index (Barthel index) ≤ 65 points; alimentary constitutional adiposity of grade II and above (BMI ≥ 35 kg/m2); acute and/or decompensation phase of the respective chronic infectious and non-infectious diseases.

The clinical group included 33 patients who underwent the prehabilitation activity complex for TKA designed by us before the surgery. The individual prehabilitation complex for TKA was identified based on the verified OA phenotype with the aid of a specialized computer program.

The age of the patients included in the study was from 41 to 70 years. The average age of patients included in the study was 61 ± 2.5 years.

In all of the patients, the X-ray pattern of the osteoarthritis of the knee joint aligned with stages III and IV according to Kellgren & Lawrence and was accompanied with the clinical picture typical of destructive and dystrophic damage of the joint at these stages. The pain syndrome at VAS score of 6 to 8 points both at rest and under mechanical stress was present in all patients. The flexion contracture of the knee joint was found in 5 (15%) patients, the amplitude of the active movement being below 90 degrees. The varus deformity of the knee joint was identified in 18 (54%) patients, and the valgus deformity in 7 (21%) patients. The signs of chronic synovitis were seen in 17 (27%) patients. Walking aids (cane) were used by 16 (48%) patients. In all patients, OA of the contralateral knee joint were seen, stage I and II according to Kellgren & Lawrence.

The patients started the prehabilitation course four weeks before the TKA and completed it 72 hours before the surgery. The patients underwent a comprehensive clinical and functional examination including a clinical examination, clinical and functional assessment using specialized questionnaire scales: VAS, WOMAC (Western Ontario and McMaster University Osteoarthritis Index), Knee injury and osteoarthritis outcome score (KOOS); movement tests: 2MWT (Two Minute Walk Test) and TUG (Timed Up and Go), superficial functional electroneuromyography (ENMG) of the quadricep and the bicep muscles of the thigh and of the gastrocnemius muscle, an X-ray examination, laboratory and diagnostic tests (general clinical and biochemical blood assay, hemostasiogram).

Based on the results of the examination for each patient, the primary syndrome and the respective OA phenotype were identified, based on which the patient was classified to one of the following three subgroups.

Subgroup 1 including patients with a severe pain syndrome (chronic pain phenotype) was based on the following criteria: complaints of a manifested pain syndrome in the articular area at rest, start-up joint pain; VAS score over 6 points; KOOS score in the ‘Pain’ section below 50 points; WOMAC score above 38 points.

Subgroup 2 included patients with prevailing inflammatory mechanism (inflammatory phenotype). Against the background of signs of chronic synovitis of the affected joint, these patients showed changes in the values of the general clinical and biochemical blood assays: WBC count exceeding 10 × 10⁹/L, ESR above 20 mm/h, С-reactive protein above 8 mg/L, fibrinogenesis level above 5 g/L.

Subgroup 3 included patients with limited mobility range in the affected joint (mechanical overload phenotype). All patients in this subgroup complained of limited mobility in the knee joint after waking up and after a long time at rest. Their KOOS score in the ‘Symptoms’ section was below 50 points; the WOMAC score was above 38 points; the ENMG of m. biceps femoris was below 25 mkV, m. rectus femoris was below 35 mkV, m. gastrocnemius was below 23 mkV; the results of the movement tests were as follows: TUG over 20 seconds, and 2MWT less than 100 meters.

It is to be noted that more than half of the patients (52%) belonged to Subgroup 1.

After dividing the patients into subgroups, the orthopedic traumatologist prescribed to them the prehabilitation complex (Fig. 1, 2). The complex was based on activities common for all subgroups: active mechanical therapy and breathing gymnastics, training of patients to walk without weight-bearing on the operated limb using walking aids (crutches or cane), learning daily activities (sitting down, getting up from the bed, putting on clothes), psychological support and use of bracing. The complex also included specific treatment procedures targeting at correction of leading physical and functional disorders in each of the subgroups: in Subgroup 1, SMC therapy, “Chinese lantern” Kinesio taping; in Subgroup 2, low-frequency magnetic therapy, W-tape Kinesio taping; in Subgroup 3, passive mechanical treatment and Y-pattern Kinesio taping.

 

Figure 1. The patient performs a physical exercise, deadlift with one leg in the starting position lying on the back, with a weight of 20 kg on a block simulator.

Рисунок 1. Выполнение пациентом физического упражнения – тяга одной ногой в исходном положении лежа на спине с отягощением 20 кг на блоковом тренажере.

 

Figure 2. SMT therapy of the affected knee joint of a patient of the first subgroup using the Amplipulse-5 device (Russia).

Рисунок 2. СМТ-терапия пораженного коленного сустава пациента первой подгруппы с помощью аппарата «Амплипульс-5» (Россия).

 

All the patients included in the study underwent total knee arthroplasty with posterior stabilized (PS) prosthetic implants. In the postoperative period, they were prescribed analgesic and anticoagulant therapy, preventive treatment with antibiotics and rehabilitation activities (physical treatment and breathing gymnastics).

The clinical and functional status of patients was assessed 72 hours before the TKA and 72 hours, 4 and 12 weeks after the surgery. For the purposes of the assessment, the results of the comprehensive examination were used that we performed 4 weeks prior to the TKA, except the X-ray and laboratory and diagnostic tests. The examination taken 72 hours before the surgery was related to the end of the prehabilitation complex and reflected the clinical, functional and psychological readiness of the patient for the surgery. The observation 72 hours after the surgery reflected the end of the verticalization period and the start of walking about the hospital room using crutches. The follow-up 4 weeks after the operation aligns with the phase of the end of aseptic inflammation of the intra- and paraarticular tissue, resolution of the edema thereof, transition to the phase of tissue remodeling in the area of the operated joint; it allowed for the evaluation of the movement range in the operated joint, weight-bearing capacity of the limb and severity of the pain syndrome that align with those processes. The evaluation of the clinical and functional condition of the operated joint 12 weeks after the surgery was performed at the stage of the end of key reparative processes of structural and functional remodeling of the tissue of the operated joint that manifested in the restoration of a complete movement regime of the patients and their return to household and professional activities.

The primary endpoint of the study was the WOMAC score reported 12 weeks after the operation that reflected the clinical and functional restoration of the affected segment of the locomotor system. The secondary endpoints were identified as reported results from the VAS and the ENMG of the quadricep and the bicep muscles of the thigh and of the gastrocnemius muscle in the two successive observations, 72 hours and 4 weeks after the TKA.

Statistical processing of the results was performed in the computer program designed by us: “Program for the Assessment of Prehabilitation Results in Total Knee Arthroplasty”³ . To test the normality of the data distribution, the Kolmogorov–Smirnov, Shapiro–Wilk and, where appropriate, Anderson–Darling tests were used sequentially. Normally distributed data were presented as M ± SD with 95% CI and analyzed using the Student’s t-test; for non-normally distributed data, the median (Me) and quartiles (Q1; Q3) were used. In all tests, differences were considered statistically significant at p < 0.05.

RESULTS

The results of assessment of the clinical and functional status of patients performed 4 weeks and 72 hours before the operation and 72 hours, 4 and 12 weeks after the TKA are presented in Table 1.

 

Parameters		4 weeks to TKA	72 hours to TKA	72 hours after TKA	4 weeks after TKA	12 weeks after TKA
KOOS “Symptoms” (points)		51.0 (37.0;58.0)	54.0 (50.0;58.0)	52.29 ± 2.52	70.03 ± 3.79	74.48 ± 3.05
KOOS “Pain” (points)		49.0 (41.0;53.0)	51.0 (50.0;54.0)	53.0 (51.0;58.0)	69.0 (67.0;71.0)	75.81 ± 3.94
KOOS “Difficulty of performing household activities” (points)		39.0 (36.0;49.0)	51.0 (50.0;54.0)	51.0 (50.0;52.0)	70.58 ± 2.84	75.23 ± 3.48
KOOS “Sports and leisure activities” (points)		5.0 (5.0;10.0)	10.0 (5.0;15.0)	10.0 (10.0;10.0)	70.0 (65.0;70.0)	75.0 (70.0;75.0)
KOOS “Quality of life assessment” (points)		23.71 ± 7.48	47.0 (43.0;49.0)	34.0 (31.0;37.0)	73.0 (71.0;75.0)	78.10 ± 3.36
WOMAC (points)		52.48 ± 7.67	38.0 (37.0;39.0)	34.0 (31.0;37.0)	24.0 (23.0;26.0)	15.0 (14.0;17.0)
VAS (points)		7.0 (6.0;7.0)	6.0 (5.0;6.0)	5.0 (4.0;5.0)	4.0 (3.0;4.0)	1.0 (0.0;1.0)
2MWT (meters)		108.0 (96.0;115.0)	115.0 (110.0;122.0)	100.11 ± 19.87	142.68 ± 15.91	154.06 ± 11.73
TUG (seconds)		14.01 (11.47;16.37)	14.20 (11.32;16.58)	15.48 ± 3.71	10.19 ± 1.77	9.56 ± 1.55
ENMG (mkV)	m. biceps femoris	29.91 ± 1.43	36.32 ± 2.15	32.06 ± 1.64	42.1 (40.8;42.7)	42.28 ± 2.55
	m. rectus femoris	40.66 ± 1.59	45.35 ± 1.77	41.05 ± 1.46	51.76 ± 1.68	60.1 (58.1;61.3)
	m. gastrocnemius	31.39 ± 1.33	40.1 (38.6;40.8)	36.2 (33.8;37.1)	45.31 ± 1.93	53.73 ± 2.14

Table 1. Results of the assessment of the clinical and functional status of patients at all follow-up periods in the pre- and postoperative periods

Таблица 1. Результаты оценки клинико-функционального состояния пациентов на всех сроках наблюдения в до- и послеоперационном периодах

 

The initial condition of patients assessed 4 weeks before the surgery was associated with manifested clinical and functional disorders, such as pain syndrome, limited movement range in the joint and chronic synovitis. The average score on the WOMAC scale was 52.48 ± 7.67, and the pain level on the VAS was 7.0 (6.0; 7.0) points. The functional tests also confirmed significant limitation of movement activity: the 2-minute walking test distance was 108.0 (96.0; 115.0) meters, and the time of the “Time up and go” test was 14.01 (11.47; 16.37) seconds.

After the prehabilitation complex was performed, 72 hours before surgery, a statistically significant improvement of the clinical and functional status of the patients was seen. The WOMAC score decreased to 38.0 (37.0; 39.0) points, which confirmed significant decrease of pain and improvement of the articular function. This dynamic was confirmed by the decrease of the pain syndrome on the VAS, the score being 6.0 (5.0; 6.0) points. Especially important was the increase of metrics in the “Quality of Life” section of KOOS, from 23.71 ± 7.48 to 47.0 (43.0; 49.0) points, which reflected the patients’ psycho-emotional readiness for the surgery. We also registered an increase in the bioelectrical activity of the inspected groups of muscles of the lower limb according to ENMG data: the activity of the quadricep muscle of the thigh increased from 40.66 ± 1.59 to 45.35 ± 1.77 mkV. The patients’ functional stamina, according to the 2MWT, increased up to 115.0 (110.0; 122.0) meters. These changes confirmed the formation of a functional reserve in patients on the eve of the surgery.

72 hours after the TKA, despite the expected deterioration of the clinical and functional condition of patients after the surgery, i.e. pain and edema in the area of the operated joint, the patients’ results were statistically significantly better than the baseline data collected before the prehabilitation. The WOMAC score was 34.0 (31.0; 37.0) points. The intensity of the pain syndrome on the VAS was at 5.0 (4.0; 5.0) points. The most illustrative at this point of follow-up was the outcome of the 2MWT: in two minutes of walking, the patients walked an average of 100.11 ± 19.87 meters, which demonstrated an improvement of their movement activity even in the early postoperative period.

Four weeks after the surgery, the WOMAC score reached 24.0 (23.0; 26.0) points. The metrics in the KOOS questionnaire improved in a statistically significant way, especially in the sections “Sports and Activity” and “Quality of Life”, where the scores reached 70.0 (65.0; 70.0) and 73.0 (71.0; 75.0) points, respectively. As per the ENMG data, the activity of the quadricep muscle reached 51.76 ± 1.68 mkV. The distance walked by patients within the 2MWT test increased to 142.68 ± 15.91 meters, which showed the levels of functional stamina that was significantly higher not only than the levels measured in the previous follow-up point but even than the baseline value.

Twelve weeks after the TKA, the patients reached high sustainable clinical and functional results. The WOMAC score was as low as 15.0 (14.0; 17.0) points showing a complete clinical and functional rehabilitation of patients. The values in all sections of the KOOS questionnaire were high, especially in the sections “Sports and Activity” and “Quality of Life”, the scores being 75.0 (70.0; 75.0) and 78.10 ± 3.36 points, respectively. The pain syndrome was minimal: 1.0 (0.0; 1.0) points on the VAS. The ENMG values of the studied muscle groups continued increasing to high values, e.g. 60.1 (58.1; 61.3) mkV for the quadricep muscle. The tolerance to physical load tested by the 2MWT test reached 154.06 ± 11.73 meters, demonstrating significant positive dynamics versus baseline level.

DISCUSSION

The obtained results correlate with the data of foreign research that demonstrate positive effects of prehabilitation in the early activation of the patient and restoration of the function of the operated joint.

In our study, we observed a key effect described in the literature, i.e. improvement of muscular force metrics on the ENMG data and gait speed from the 2MWT and TUG test results as early as 4 weeks after the surgery. Improved bioelectrical activity of the quadricep muscle of the thigh 72 hours after the end of the prehabilitation complex and its faster restoration by the 4th and 12th weeks after the surgery correlated with findings to the effect that the preoperative strengthening of the stabilizer muscles of the knee joint was also a prerequisite to the successful postoperative rehabilitation.

Our study results also confirmed the positive impact of prehabilitation on pain. Despite a natural increase in pain in the first 72 hours after surgery, the VAS pain level remained below preoperative baseline values, which facilitated more comfortable vertical positioning and patient activity.

It is to be noted that the use of a multimodal and individualized approach, taking into account the leading OA phenotype, allowed us to target key pathogenetic factors. This resonates with the current trend toward developing combined prehabilitation programs that include, in addition to kinesiotherapy, physical therapy, orthotics, and psychological support.

CONCLUSION

The developed approach to prehabilitation of patients undergoing TKA, based on phenotypic stratification of OA and the use of an individualized treatment package, demonstrated statistically significant improvement in clinical and functional parameters in the preoperative period. The proposed prehabilitation package resulted in a reduction in pain severity according to the VAS and WOMAC scales, improved KOOS scores, an increase in the 2MWT distance, and increased bioelectrical activity of the quadriceps, biceps femoris, and gastrocnemius muscles, as measured by functional ENMG of the lower limbs.

In the postoperative period, positive dynamics of the clinical and functional condition of patients were registered at 4 and 12 weeks after the surgery, demonstrated in the restoration of the movement range, weight-bearing capacity of the limb ad reduction of the pain syndrome.

The obtained results allow us to consider the proposed approach to prehabilitation of patients with knee osteoarthritis as a promising approach to optimizing preoperative preparation for total knee arthroplasty. Controlled trials with a comparison group are recommended for a definitive assessment of the clinical efficacy of the developed method.

 

ADDITIONAL INFORMATION	ДОПОЛНИТЕЛЬНАЯ ИНФОРМАЦИЯ
Ethical approval. The present study was carried out in accordance with the ethical standards of the World Medical Association’s Declaration of Helsinki (Helsinki, 2024), Order No. 200n of the Ministry of Health of the Russian Federation dated April 1, 2016, «On Approval of the Rules for Good Clinical Practice» and Minutes No. 292 of the Committee on Bioethics at Samara State Medical University dated September 4, 2024.	Этическая экспертиза. Настоящее исследование осуществляли в соответствии с этическими нормами Хельсинкской декларации Всемирной медицинской ассоциации (Хельсинки, 2024), приказом Минздрава России № 200н от 01.04.2016 г. «Об утверждении правил надлежащей клинической практики» и протоколом № 292 заседания комитета по биоэтике при СамГМУ от 04 сентября 2024 г.
Study funding. The study was the authors’ initiative without external funding.	Источник финансирования. Работа выполнена по инициативе авторов без привлечения финансирования.
Conflict of interest. The authors declare that there are no obvious or potential conflicts of interest associated with the content of this article.	Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
Consent to publication. The authors obtained from the patients who took part in the study a voluntary informing consent to the publication of medical data in an impersonal form in the peer-reviewed journal of medical research and practice «Science and Innovations in Medicine».	Согласие на публикацию. Авторы получили от пациентов, принимавших участие в исследовании, добровольное информирование согласие на публикацию медицинских данных в обезличенной форме в медицинском рецензируемом научно-практическом журнале «Наука и инновации в медицине».
Contribution of individual authors. Kotelnikov G.P.: scientific supervision, editing of the text, study concept. Kolsanov A.V.: study design. Kudashev D.S.: statistical data processing. Moseev O.I.: writing of the text. Zuev-Ratnikov S.D.: data collection. Shishkina A.A.: data processing. Dolgushkin D.A.: literature review. All authors gave their final approval of the manuscript for submission, and agreed to be accountable for all aspects of the work, implying proper study and resolution of issues related to the accuracy or integrity of any part of the work.	Участие авторов. Котельников Г.П.: научное руководство, редактирование текста, концепция исследования. Колсанов А.В.: дизайн исследования. Кудашев Д.С.: статистическая обработка данных. Мосеев О.И.: написание текста. Зуев-Ратников С.Д.: сбор материалов. Шишкина А.А.: обработка материала. Долгушкин Д.А.: обзор литературы. Все авторы одобрили финальную версию статьи перед публикацией, выразили согласие нести ответственность за все аспекты работы, подразумевающую надлежащее изучение и решение вопросов, связанных с точностью или добросовестностью любой части работы.
Statement of originality. No previously published material (text, images, or data) was used in this work.	Оригинальность. При создании настоящей работы авторы не использовали ранее опубликованные сведения (текст, иллюстрации, данные).
Data availability statement. The editorial policy regarding data sharing does not apply to this work.	Доступ к данным. Редакционная политика в отношении совместного использования данных к настоящей работе не применима.
Generative AI. No generative artificial intelligence technologies were used to prepare this article.	Генеративный искусственный интеллект. При создании настоящей статьи технологии генеративного искусственного интеллекта не использовали.
Provenance and peer review. This paper was submitted unsolicited and reviewed following the standard procedure. The peer review process involved 2 external reviewers.	Рассмотрение и рецензирование. Настоящая работа подана в журнал в инициативном порядке и рассмотрена по обычной процедуре. В рецензировании участвовали 2 внешних рецензента.

 

¹ Patent of the Russian federation for the invention No. 2844621 dated 04.08.2025.

² Certificate of State registration of computer software No. 2026610177 dated 13.01.2026.

³ Certificate of State registration of computer software No. 2025662976 dated 23.05.2025.

About the authors

Gennadii P. Kotelnikov

Samara State Medical University

Email: g.p.kotelnikov@samsmu.ru
ORCID iD: 0000-0001-7456-6160

MD, Academician of the Russian Academy of Sciences, Dr. Sci. (Medicine), Professor, Head of the Department of Traumatology, Orthopedics and Extreme Surgery named after Academician of the RAS A.F. Krasnov.

Russian Federation, Samara

Alexander V. Kolsanov

Samara State Medical University

Email: a.v.kolsanov@samsmu.ru
ORCID iD: 0000-0002-4144-7090

MD, Corresponding Member of the Russian Academy of Sciences, Dr. Sci. (Medicine), Professor, Head of the Department of Operative Surgery and Topographic Anatomy.

Russian Federation, Samara

Dmitrii S. Kudashev

Samara State Medical University

Email: d.s.kudashev@samsmu.ru
ORCID iD: 0000-0001-8002-7294

MD, Dr. Sci. (Medicine), Associate professor, Professor of the Department of Traumatology, Orthopedics and Extreme Surgery named after Academician of the RAS A.F. Krasnov.

Russian Federation, Samara

Oleg I. Moseev

Samara State Medical University

Author for correspondence.
Email: o.i.moseev@samsmu.ru
ORCID iD: 0009-0004-6821-7035

postgraduate student at the Department of Traumatology, Orthopedics and Extreme Surgery named after Academician of the RAS A.F. Krasnov.

Russian Federation, Samara

Sergei D. Zuev-Ratnikov

Samara State Medical University

Email: stenocardia@mail.ru
ORCID iD: 0000-0001-6471-123X

MD, Cand. Sci. (Medicine), Associate professor, Associate professor of the Department of Traumatology, Orthopedics and Extreme Surgery named after Academician of the RAS A.F. Krasnov.

Russian Federation, Samara

Anna A. Shishkinа

Samara State Medical University

Email: a.a.shishkina@samsmu.ru
ORCID iD: 0000-0003-0586-8039

MD, Cand. Sci. (Medicine), Associate professor, Head of the Department of Medical Rehabilitation, Sports Medicine, Physiotherapy and Balneology.

Russian Federation, Samara

Dmitrii A. Dolgushkin

Samara State Medical University

Email: d.a.dolgushkin@samsmu.ru
ORCID iD: 0000-0003-3681-5044

MD, Cand. Sci. (Medicine), Associate professor, Associate professor of the Department of Traumatology, Orthopedics and Extreme Surgery named after Academician of the RAS A.F. Krasnov.

Russian Federation, Samara

References

Supplementary files