This information has been written for patients who are undergoing knee replacement surgery under Dr Jobe Shatrov.

Dr Shatrov provides general information about the surgery including the risks and benefits involved. It also explains what will happen in hospital and when you are discharged. Please note that this information is generic and variations are likely to occur from patient to patient.

Total knee replacement is a treatment option for patients who have osteoarthritis of the knee. Your surgeon may recommend a knee replacement based on a number of factors, if they consider you to be eligible. The knee joint is considered to be made of the 3 compartments; the medial compartment which is the inside of the knee, the lateral compartment which is the outside and the patellofemoral compartment which is the front of the kneecap between the kneecap and the thigh bone. Generally, a total knee replacement is required if more than 1 of these compartments is affected by arthritis.

In some circumstances it is possible to replace both knees in one procedure. Whilst performing bilateral total knee replacements in a single operation has been shown to be safe, some individuals may not be eligible based on their medical history or age. This should be discussed with your specialist.

What is a knee replacement

In a knee replacement the ends of the bone are removed and replaced with an artificial joint referred to as a prosthesis. There are different types of prostheses available and variations between patients based on their needs dictates the type of implant that may be required. For most patients, a total knee replacement will be performed where both the femur, tibia and patella will be resurfaced. The femur and tibia are typically resurfaced with a metal implant that is usually made of cobalt and chrome, and the patella is usually resurfaced with a plastic insert. These implants are fixed to the bone usually with some bone cement which acts as a fixative. The interlocking components of the new joint allow it to move but also provide it with some stability. It is important to understand that the joint that is replacing yours is different in that it will have no sensation or nerve endings and so it is going to feel different from your native knee joint.

Advantages and disadvantages of total knee replacement surgery

The main benefit of a knee replacement is to relieve pain. Approximately 8 to 9 out of 10 patients are satisfied and happy with the joint replacement. However, one in 10 are disappointed and a further one in 10 are sometimes unsure if it has actually helped their symptoms. The reduction in pain will help restore quality of life and provide the patient with the ability to perform activities of daily living that they would’ve otherwise struggled with. If you are otherwise fit, you should be able to walk easily, drive and perform gentle exercises such as golf, swimming, cycling and even tennis.

Although a replacement can alleviate symptoms, it is never as good as a natural joint. You may find that it will not bend quite as much as you like it to, or you may also be aware of abnormal sensations. This can include clicking or clunking. Often patients describe the sensation of feeling the plastic of the patella touching the metal prosthesis and creating a knocking sound. You may also have some sensitivity around the scar which, together with the restriction of movement, may prevent some patients from kneeling. There is always going to be some numbness around the incision site following a total knee replacement. This patch of numbness will usually get smaller with time, but a small region will remain permanent.

Preparation prior to surgery

In order to prepare for joint replacement surgery a number of things should be considered. In a majority of cases you will be referred to a physician for a pre-operative assessment and screening of health conditions to determine if there are any medical optimisations that should be carried out prior to surgery,

Muscle strength and conditioning

There is evidence to demonstrate that patients who improve their quadriceps strength and mobility prior to a total knee replacement make both a faster recovery and tend to recover greater function following the surgery. It is recommended that 3 months prior to your surgery you undertake a strength and conditioning program supervised by a qualified medical or health professional such as a physiotherapist.

Supplements

Prior to surgery, it is critical that you maintain good health. As part of this some supplements have been shown to be beneficial. These include iron supplementation to boost haemoglobin levels, along with vitamin C and vitamin D to improve your immune system and bone health. In addition to this,  patients should ensure that they have a healthy diet that avoids excessive consumption of alcohol. For patients with diabetes, good blood glucose control is critical for reducing the risk of post-surgery complications such as infection and wound breakdown.

Iron supplementation may not be recommended in some individuals with certain medical conditions. Advice should be sought from your medical practitioner before commencing this medication.

Recent evidence has emerged showing the use of branched chain amino acid supplements enhances muscle recovery following knee surgery. Whilst this was a small study, it was a randomised controlled trial comparing to a placebo supplement and demonstrated less fatty striations in the leg muscles of patients taken the supplement. Branch chain amino acid supplements are not suitable in patients with kidney disease or poorly controlled diabetes. They can be purchased if the patient wishes to use them as adjunct in their recovery

Pre-existing medical conditions

You will be asked about your medical history. It is important that you accurately inform your specialist of any conditions affecting your heart, lungs, blood pressure, kidneys, or circulation. It is also critical to inform your doctor of any conditions that may affect your immune system, such as diabetes. Patients will be assessed in a preadmission clinic prior to the surgery. The purpose of the preadmission clinic is to:

1. Obtain a thorough medical and surgical history

2. Conduct blood tests, x-rays, ECG, skin swabs and other investigations

3. Understand needs and answer your questions

Medications

10 days prior to surgery some medications need to stop. These may include aspirin, nonsteroidal anti-inflammatories, garlic capsules and fish oil. If you’re taking blood thinners such as aspirin, Plavix or warfarin, these may need to stop but will likely need to be done in conjunction with the advice from either your general practitioner or another specialist, such as a cardiologist. It is critical that you inform your specialist if you are taking these medications.

Skin care

It is vitally important that you have no cuts, scratches or skin infections as these increase the risk of infection and may lead to your surgery been postponed. Do not wax or shave your legs in the week prior to surgery.

Smoking

It is recommended to cease smoking for at least 6 weeks prior to surgery. People who smoke have an increased complication rate for events such as a DVT, infection, or wound complications.

Dental hygiene

Infections in other parts of the body can cause bacteria to enter to your bloodstream and this can lead to a prosthetic joint infection. To reduce your risk of infection, major dental procedures should be done prior to you having any joint replacement surgery. If dental surgery is required following a joint replacement you must inform the dentist that you are required to take a preventative antibiotic to minimise the chance of a blood-borne infection.

The day of the surgery

You will usually be admitted to hospital on the day of surgery. Typically, the hospital will contact you the day prior, usually in the afternoon, to inform you of your arrival time and fasting details. The anaesthetists will also contact you prior to the surgery and ask you a number of questions about your medical and anaesthetic history. They will likely also discuss the type of anaesthetic that they propose to use. In some cases, you may receive a spinal anaesthetic. 

Spinal anaesthesia carries the benefit of reducing arterial and venous pressure so the blood loss is reduced, which can mean that a light general anaesthetic is given. This will reduce the post anaesthetic symptoms. It also provides good post-operative pain relief; however some patients may not be suitable for this type of anaesthesia and the options will be discussed with the patient based on your medical history.

On admission, the leg will usually be washed and shaved if necessary. An antiseptic solution will be applied to the limb, and it will be wrapped with a sterile towel. Prior to the surgery you will be repeatedly asked to confirm the side of the operation along with what operation you are having. These form part of important preoperative checks that the hospital staff perform.

The surgery will be carried out through an incision over the front of the knee. The surgery typically takes 1 to 2 hours. Small parts of the ends of the bone are removed and replaced with a prosthesis which is matched to your side and size. Typically, some sort of assistive device such as a computer or robot is used to help guide the surgery. The precise amount of bone removed is determined by a combination of preoperative planning and intraoperative decisions  made by your surgeon. If a computer or robotic assistance is used, additional skin incisions will appear on your leg where tracking devices were placed on the limb during the surgery for the assistive technology. The use of these robotic tools has been shown to be more accurate and provides the surgery with more data regarding the alignment of the leg. 

The prostheses are fixed to bone usually by cement. Intravenous are given to you before the surgery, along with several doses afterwards. During the surgery several medications, including local anaesthetic, will be infiltrated into the tissues around the knee and this will provide good pain relief usually for the first 24 hours post-surgery. In some cases, a urinary catheter will be placed into your bladder for 1 to 2 days.

If a robot is uses for the surgery, it is important to note that additional imaging such as a CT scan may be required PRIOR to your operation. Dr Shatrov will inform you if this is the case. Robotic surgery has been shown to lead to faster recovery after knee replacement surgery and reduce certain complications as well as improve the accuracy of the surgery. Long-term data about it’s efficacy compared to traditional techniques are still emerging.

After Surgery

Most patients will wake up in recovery. Pain relief following surgery is provided as required by several medications that will be charted by your anaesthetist. The nursing staff will assist you to achieve the best pain control with the least amount of side effects. The day after surgery the bulky dressing on your leg is removed. Stockings are attached to your leg and a number of medications are given to you whilst you are in hospital such as a blood thinning injection to reduce your risk of a DVT. You will be offered the opportunity to hire a compressive ice sleeve which helps reduce post-operative inflammation, pain, and swelling.

An x-ray and blood test will be performed to monitor you following the surgery. 

You will be seen by a physiotherapist and shown exercises as well as being as shown how to walk after your surgery. Physiotherapy following the surgery is important to help achieve a good range of motion, present motor mobility and start muscle strengthening exercises. Generally, the stronger and more mobile you are prior to the surgery, the faster the recovery tends to be. Hence, you are encouraged prior to the surgery to work on strengthening the quadriceps and promoting use of your limb.

Discharge from hospital occurs when you have been deemed safe by the nursing, medical and occupational physiotherapists. The average length of stay in hospital is 4 to 5 days after joint replacement but some patients may be faster or slower than this. Following this, patients will either be offered inpatient or outpatient rehabilitation. Most patients will be deemed appropriate for outpatient rehabilitation and will do this either through a program run by the hospital or through a physiotherapist that they have developed a relationship with. The decision to go to inpatient rehabilitation is made in hospital and is a joint decision between the medical physician, Dr Shatrov, nursing staff and allied health staff.

Pain After the Surgery

Total knee replacement is painful surgery. You will experience some pain from the operation, however this will be controllable with regular painkillers. As you get moving and return to normal activities, the pain will settle down over the next few weeks. You should tell your nurse straight away if you have any pain between your scheduled medications.

You should aim to use pain medications to make yourself comfortable enough to move about in bed and do exercise with the physiotherapist. This will help you get better faster. You’ll have bruising and swelling in your leg which can make things feel stiff and uncomfortable. This often feels worse after you have been sitting or lying for long periods so try to avoid being dormant for long periods of time. Typically, the pain and swelling is worse 2 to 3 days after the surgery.

If you are in pain, it is important that you let the nursing staff know as they can arrange your drugs to be altered. Remember to take any painkillers regularly to make them more effective. Keeping your knee pain-free will make it easier to move. Some painkillers can cause constipation or can also make people confused. You will likely be placed on laxatives to help alleviate any constipation. Regularly applying ice for 10 to 15 minutes at a time following your surgery will likely help alleviate pain and control post-operative swelling in the first two weeks. Ice is usually not recommended or necessary more than two weeks following the surgery.

Weight-Bearing

Typically, patients are allowed to fully weight-bear with crutches. If weight-bearing is permitted, crutches are still required until the quadriceps have regained control of the knee and walking can be performed safely and this will be determined with the supervision of a physiotherapist.

Bandages and Dressings

On the first after surgery, the bandages on the knee are removed and a compressive bandage called a tubigrip, which has been placed underneath from mid shin to mid-thigh, is left in place. The dressings are kept dry and in place until the wound review, which is performed with the surgeon typically 10 to 14 days after the surgery. If the bandaging becomes soaked either with blood or otherwise the patient should return either to the clinic, or if this is not possible, to the hospital to have the dressings changed.

Stitches in the incisions may be dissolving, however are sometimes still removed between days 10-14 on a return visit to consultation for a wound review. The knee needs to remain dry. Swimming, bathing, spa’s, sauna etc. is not allowed until wound healing is confirmed Typically 4 weeks). In order to shower, a water-proof sleeve that fits over the knee can be purchased from the chemist.

• Waterproof dressings have been applied to the skin that allow patient to shower

• Small amounts of ooze that can be seen on the dressings are a normal part of the routine post operative experience and are of no concern.

•  If there is a larger amount of blood that leaks from a dressing, this is very rare. Over wrap the area with 2 x extra crepe bandages with a firm pressure. Rest the knee and avoid excessive walking. Contact Dr Shatrov' Practice Manager at the next available time so an urgent review can be arranged. 

Exercises

Exercises to activate the quadriceps and gluteal muscle are performed, and calf pumping exercises encouraged to circulate blood throughout the leg. The focus initially should be on achieving full extension of the knee and activating the quadriceps muscles. Flexion of the knee is typically encouraged as well but may be limited by pain. Regularly bending exercises are critical early on to prevent the formation of scar tissue that leads to stiffness. 

Medications

A blood thinning medication is often prescribed for at least two, and in some cases 6 weeks following surgery to reduce the risk of DVT’s. 

Pain relief is prescribed and typically involves the following; 

• Paracetamol 1 g every 6 hours (if the patient does not have either an allergy to this medication or pre-existing liver disease) 

• A nonsteroidal anti-inflammatory which is typically either 1 of celecoxib, meloxicam or Volatren. This should not be taken if the patient has kidney problems, high blood pressure, may be pregnant or has reflux. 

• Breakthrough stronger pain killer: This will depend on your medical history but is usually either Targin, tapentadol (palexia) or endone (oxycodone)

Additional pain killers are often prescribed but depend on a variety of factors including the anaesthetist’s preference, the patient's preference, and pre-existing medical conditions as well as their medication history. Local anaesthetic is typically injected at the time of surgery and often wears off 12 to 18 hours after being inserted. This is often accompanied with gradually increasing pain at that time. Medications are to be purchased upon discharge from the hospital. Ongoing scripts if required should be sort from your GP.

Driving 

Driving is not permitted until sufficient muscle control has been regained to allow for emergency breaking. The length of time that this takes varies depending on the surgery, but the recommended tie is 6 weeks.  Driving is also not allowed whilst taking certain medications. For more information about this please consult either your general practitioner or your orthopaedic surgeon.

Showering

Showering is permitted but the wound needs to remain dry. A sleeve can be purchased from some chemists. Alternatively, a bag can be wrapped around the leg in order to keep it dry.

Bracing

Bracing is not performed routinely required.

Physiotherapy

A critical component of recovery is a supervised rehabilitation program with a physiotherapist. Physiotherapy should be arranged prior to surgery and the details of the physiotherapist shared with the surgeon so they can communicate as required during your recovery. The frequency and duration of therapy will be determined by the physiotherapist but should commence within a week of the surgery.

Rehabilitation

A good rehabilitation programme is a critical component of your recovery. The aim will be for you to resume most of your normal activities of daily living within 3 to 6 weeks following the surgery. Night pain is common for the first 6 to 12 weeks following the surgery and usually requires analgesia by day and a stronger longer acting one prior to bed. It is routine for patients to be using some sort of walking aid, typically for the first 6 to 12 weeks. This will be done in conjunction with a physiotherapist.  Most patients will drive a vehicle again after 6 weeks when you are confident operating the pedals with sufficient power and speed to drive safely.

A wound review will happen in the rooms 2 weeks after your procedure if  you have been discharged home. If you are in rehabilitation, the wound check will happen there. The first post-operative appointment will depend on whether you have gone home or to rehabilitation. If you have gone home, the first post-operative appointment will be your 2 weeks wound check appointment. However, if you have gone to rehab the first post-operative appointment will be 6 weeks after your procedure. The typical recovery time after a knee replacement is 3 months and most patients experience improvement in symptoms for 12 to 18 months following surgery. You will be required to have an annual review for the first few years following the joint replacement.

Post Operative Appointments

You will need to have the wound checked two weeks following the surgery either by Dr Shatrovs team if you have been discharged home or by the rehabilitation team if you are in rehabilitation.

Surgeon

At six weeks following your surgery, your surgeon will follow up with you usually via Tele health or maybe in person if arranged otherwise. The frequency of further appointments will be organised on an as needs basis and will vary from individual to individual.

Physiotherapist

You will need to attend physiotherapy following your surgery. This will be performed on an outpatient basis. 

Long Term Recovery

Recovering from a major operation takes time and you may feel tired for several weeks. You should avoid any major commitments for six weeks, avoid long haul travel, and you will also not be able to drive for six weeks.

Most of the improvement following knee surgery is made in the first few months but your knee continues to improve for up to 2 years as the muscles get stronger and the tissues heal. The following is some advice for optimising your recovery:

• Do not stop using your walking aid until you can walk without a limp, and you feel confident without them. This is usually when you have regained quadriceps control.

• Do not lie or sit with a pillow underneath your knee. Although this may feel comfortable, it can lead to your knee permanently being stuck in a position where it will not come out straight and this can leave you with a permanent limp.

• You should continue to take your painkillers at first in order for you to perform your exercises. Consult your GP about weaning yourself safely from medications, particularly any medications that include opioids or so-called narcotics.

• Gradually increase your activities each day as the pain and swelling allows. If you overdo things, the pain and swelling may increase. If this happens, rest your leg and keep it elevated and use an ice pack. Reduce your activities until it settles and then gradually increase them thereafter.

• It is normal for the knee to feel hot to touch. It will be warmer than the other side for up to 1 year following the surgery. This is as a result of the increase in blood flow to the joint and also the fact that the joint resides directly beneath the skin.

• Remember, you are not permitted to have hydrotherapy or swim in the ocean or in fresh water for at least six weeks following your joint replacement. If there are any wound complications this period may be extended. Doing so may increase the risk of getting a deep joint infection.

Potential Risks and Complications

Infection

Whilst this is a rare complication which been quoted as 1 in 200 in the literature, it can be devastating. A lot of caution is taken both before, during, and after the surgery to reduce the risk of infection, however it can still occur. When deep infections occur, it will require further surgery to flush out the infection and may even require the removal of the implant, prolonged antibiotics, and multiple surgeries. If any fever, wound redness, swelling or increasing pain occurs you should immediately report this to the practice staff or attend your nearest emergency department.

Blood clots

Deep vein thrombosis or DVT occurs when a large vein of the leg forms  a blood clot, which can lead to an even more serious complication called a pulmonary embolism. Pulmonary lesions can be fatal if left untreated. Whilst these are rare due to the fact that there are serious a number of precautions are taken to reduce the risk of occurrence, such as early mobilisation, the use of compressive stockings, foot and ankle pumping exercises and taking blood thinning medications after your surgery.

Nerve or blood vessel injury

Several major nerves and vessels run very close to the knee and are at risk of injury during the surgery. Whilst this is rare, the risk is still present and when it occurs can lead to permanent loss of muscle power in the leg. There are a number of small nerves that supply the skin in front of the knee and these cuts during the surgery can result  in a numb patch on the outside of the leg being noticed by the patient. Whilst it is usually of no functional significance, some patients are aware of it.

Difficulty kneeling

Some patients complain of feeling uncomfortable when they try to kneel on the knee after a knee replacement. Whilst it is possible, some patients just do not feel comfortable doing so and thus prefer not to.

Other complications

Other complications such as stiffness resulting in difficulty bending or extending the knee may occur. This may require further surgery or an extended period of physiotherapy. Wound healing issues may also occur, and some patients may have an allergic reaction to either medication or a dressing which can cause wound issues.

Ongoing pain after the surgery is a possibility. The dissatisfaction rate following a total knee replacement is quoted to be approximately 12% in the literature. It is important that prior to the surgery, you feel confident in your decision.

Fracture

It is possible to develop a stress fracture either around the knee replacement or a full fracture if you fall onto your knee following knee replacement surgery. This may require surgery depending on the fracture pattern.

Overall results

The date of the satisfied following a joint placement of the knee is approximately 90%. 90 to 95% of patients have the majority of their pain relieved. 

Long-term, the prosthesis can wear out or loosen and this may require further surgery. The prosthesis is a mechanical device and has a bearing surface which can wear out over time. In rare cases failure of the bearing surface (the plastic liner between the femur and tibia) can occur. This was more common with older sterilisation techniques which are less commonly used for prosthetics and is more common in people who have high activity levels or who are young at the time of implantation. It is also therefore important to avoid excessive weight gain following the surgery.

Precautions after surgery

It is advised that you do not perform running or high impact jarring activities. This may lead to the prosthesis loosening or failing. Whilst case reports exist of people doing high-impact sporting activities  it is not recommended.

You are permitted to do walking, swimming from 4 weeks after the surgery if there were no wound issues, golf, bowls, doubles tennis and gym work. It is advised that you avoid excessive weight gain.

If you have any dental procedures you should advise a dentist that you had an implant and they will prescribe you with an antibiotic prior to any invasive dental work. If you are prone to urinary tract infections, you should pay particular attention to your symptoms so that if they occur you are placed on  antibiotics immediately.

If you have diabetes or are prone to skin infections, you should pay particular attention to both controlling the diabetes but also avoiding getting any skin infections as these can lead to bacteria seeping into your bloodstream and infecting the implant.

Publications by Dr Shatrov on Total Knee Replacement Surgery

1. Shatrov J, Foissey C, Kafelov M, Batailler C, Gunst S, Servien E, Lustig S. Functional Alignment Philosophy in Total Knee Arthroplasty-Rationale and Technique for the Valgus Morphotype Using an Image Based Robotic Platform and Individualized Planning. J Pers Med. 2023 Jan 26;13(2):212. doi: 10.3390/jpm13020212. PMID: 36836446.

2. Murphy GT, Shatrov J, Duong J, Fritsch BA. How does the use of quantified gap-balancing affect component positioning and limb alignment in robotic total knee arthroplasty using functional alignment philosophy? A comparison of two robotic platforms. Int Orthop. 2023 May;47(5):1221-1232. doi: 10.1007/s00264-022-05681-x. Epub 2023 Feb 6. PMID: 36740610; PMCID: PMC10079723.

3. Fernandez A, Sappey-Marinier E, Shatrov J, Batailler C, Neyret P, Huten D, Servien E, Lustig S. Preoperative flexion contracture does not affect outcome in total knee arthroplasty: a case-control study of 2,634 TKAs. Orthop Traumatol Surg Res. 2023 Mar 14:103592. doi: 10.1016/j.otsr.2023.103592. Epub ahead of print. PMID: 36924881.
   
   

4. Deroche E, Batailler C, Shatrov J, Gunst S, Servien E, Lustig S. Similar survival rate but lower functional outcomes following TKA in the elderly people compared to younger patients: analysis of a posterior stabilised implant with minimum 5-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2023 Apr;31(4):1470-1476. doi: 10.1007/s00167-022-07287-7. Epub 2022 Dec 20. PMID: 36538057.
   
   

5. Shatrov J, Foissey C, Batailler C, Gunst S, Servien E, Lustig S. How long does image based robotic total knee arthroplasty take during the learning phase? Analysis of the key steps from the first fifty cases. Int Orthop. 2023 Feb;47(2):437-446. doi: 10.1007/s00264-022-05618-4. Epub 2022 Nov 10. PMID: 36355082.

6. Deroche E, Batailler C, Shatrov J, Gunst S, Servien E, Lustig S. No clinical difference at mid-term follow-up between TiN-coated versus uncoated cemented mobile-bearing total knee arthroplasty: a matched cohort study. SICOT J. 2023;9:5. doi: 10.1051/sicotj/2023001. Epub 2023 Feb 9. PMID: 36757220; PMCID: PMC9910165.

7. Shatrov J, Coulin B, Batailler C, Servien E, Walter B, Lustig S. Alignment philosophy influences trochlea recreation in total knee arthroplasty: a comparative study using image-based robotic technology. Int Orthop. 2022 Sep 16. doi: 10.1007/s00264-022-05570-3. Epub ahead of print. PMID: 36112197.

8. Erard J, Schmidt A, Batailler C, Shatrov J, Servien E, Lustig S. Higher knee survivorship in young patients with monocompartmental osteoarthritis and constitutional deformity treated by high tibial osteotomy then total knee arthroplasty compared to an early total knee arthroplasty : a comparative study at a minimum follow-up of ten years. Bone Jt Open. 2023 Feb;4(2):62-71. doi: 10.1302/2633-1462.42.BJO-2023-0002.R1. PMID: 36722347; PMCID: PMC10011927.

9. Favroul C, Batailler C, Canetti R, Shatrov J, Zambianchi F, Catani F, Servien E, Lustig S. Image-based robotic unicompartmental knee arthroplasty allowed to match the rotation of the tibial implant with the native kinematic knee alignment. Int Orthop. 2023 Feb;47(2):519-526. doi: 10.1007/s00264-022-05637-1. Epub 2022 Nov 24. PMID: 36422703.

10. Sappey-Marinier E, Fratini S, Kremer H, Shatrov J, Batailler C, Servien E, Lustig S. Similar outcomes to primary total knee arthroplasty achievable for aseptic revision using the same primary posterior-stabilised prosthesis at a mean follow-up of 49 months. Knee Surg Sports Traumatol Arthrosc. 2022 Aug;30(8):2854-2861. doi: 10.1007/s00167-021-06716-3. Epub 2021 Sep 2. PMID: 34476561.

11. Sappey-Marinier E, Meynard P, Shatrov J, Schmidt A, Cheze L, Batailler C, Servien E, Lustig S. Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs. Knee Surg Sports Traumatol Arthrosc. 2022 Jan 11. doi: 10.1007/s00167-021-06832-0. Epub ahead of print. PMID: 35013747.

12. Shatrov J, Colas A, Fournier G, Batailler C, Servien E, Lustig S. Can Patella Instability After Total Knee Arthroplasty be Treated With Medial Patellofemoral Ligament Reconstruction? Arthroplasty Today. 2022 Jun 4;16:130-139. doi: 10.1016/j.artd.2022.04.006. PMID: 35677944; PMCID: PMC9168055.

13. Shatrov J, Colas A, Fournier G, Batailler C, Servien E, Lustig S. Tibial tuberosity osteotomy and medial patellofemoral ligament reconstruction for patella dislocation following total knee arthroplasty: A double fixation technique. SICOT J. 2022;8:23. doi: 10.1051/sicotj/2022023. Epub 2022 Jun 14. PMID: 35699459; PMCID: PMC9196027.

14. Shatrov J, Batailler C, Sappey-Marinier E, Gunst S, Servien E, Lustig S. Kinematic alignment fails to achieve balancing in 50% of varus knees and resects more bone compared to functional alignment. Knee Surg Sports Traumatol Arthrosc. 2022 Aug 13. doi: 10.1007/s00167-022-07073-5. Epub ahead of print. PMID: 35962840.

15. Shatrov J, Battelier C, Sappey-Marinier E, Gunst S, Servien E, Lustig S. Functional Alignment Philosophy in Total Knee Arthroplasty - Rationale and technique for the varus morphotype using a CT based robotic platform and individualized planning. SICOT J. 2022;8:11. doi: 10.1051/sicotj/2022010. Epub 2022 Apr 1. Erratum in: SICOT J. 2022;8:18. PMID: 35363136; PMCID: PMC8973302.

16. Shatrov J, Sappey-Marinier E, Kafelov M, Gunst S, Batailler C, Servien E, Lustig S. Similar outcomes including maximum knee flexion between mobile bearing condylar-stabilised and fixed bearing posterior-stabilised prosthesis: a case control study. J Exp Orthop. 2022 Feb 15;9(1):17. doi: 10.1186/s40634-022-00456-0. PMID: 35169966; PMCID: PMC8847635.

17. Sappey-Marinier E, Meynard P, Shatrov J, Schmidt A, Cheze L, Batailler C, Servien E, Lustig S. Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs. Knee Surg Sports Traumatol Arthrosc. 2022 Jan 11. doi: 10.1007/s00167-021-06832-0. Epub ahead of print. PMID: 35013747.

18. Batailler C, Shatrov J, Sappey-Marinier E, Servien E, Parratte S, Lustig S. Artificial intelligence in knee arthroplasty: current concept of the available clinical applications. Arthroplasty. 2022 May 2;4(1):17. doi: 10.1186/s42836-022-00119-6. PMID: 35491420; PMCID: PMC9059406.

19. Shatrov J, Murphy GT, Duong J, Fritsch B. Robotic-assisted total knee arthroplasty with the OMNIBot platform: a review of the principles of use and outcomes. Arch Orthop Trauma Surg. 2021 Dec;141(12):2087-2096. doi: 10.1007/s00402-021-04173-8. Epub 2021 Oct 15. Erratum in: Arch Orthop Trauma Surg. 2021 Nov 10;: PMID: 34652515.

20. Elliott J, Shatrov J, Fritsch B, Parker D. Robotic-assisted knee arthroplasty: an evolution in progress. A concise review of the available systems and the data supporting them. Arch Orthop Trauma Surg. 2021 Dec;141(12):2099-2117. doi: 10.1007/s00402-021-04134-1. Epub 2021 Sep 7. PMID: 34491411.

21. Sappey-Marinier E, Shatrov J, Batailler C, Schmidt A, Servien E, Marchetti E, Lustig S. Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case-control study. Knee Surg Sports Traumatol Arthrosc. 2021 Aug 23. doi: 10.1007/s00167-021-06714-5. Epub ahead of print. PMID: 34424356.

22. Shatrov J, Parker D. Computer and robotic - assisted total knee arthroplasty: a review of outcomes. J Exp Orthop. 2020 Sep 24;7(1):70. doi: 10.1186/s40634-020-00278-y. PMID: 32974864; PMCID: PMC7516005.

23. Sappey-Marinier E, Shatrov J, Batailler C, Schmidt A, Servien E, Marchetti E, Lustig S. Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case-control study. Knee Surg Sports Traumatol Arthrosc. 2021 Aug 23. doi: 10.1007/s00167-021-06714-5. Epub ahead of print. PMID: 34424356.

24. Kafelov M, Batailler C, Shatrov J, Al-Jufaili J, Farhat J, Servien E, Lustig S. Functional positioning principles for image-based robotic-assisted TKA achieved a higher Forgotten Joint Score at 1 year compared to conventional TKA with restricted kinematic alignment. Knee Surg Sports Traumatol Arthrosc. 2023 Dec;31(12):5591-5602. doi: 10.1007/s00167-023-07609-3. Epub 2023 Oct 18. PMID: 37851026.

25. Shatrov J, Coulin B, Batailler C, Servien E, Brivio A, Barrett D, Walter B, Lustig S. Redefining the concept of patellofemoral stuffing in total knee arthroplasty. J ISAKOS. 2024 Nov 20;10:100364. doi: 10.1016/j.jisako.2024.100364. Epub ahead of print. PMID: 39577567.
    
    

26. Shatrov J, Khasian M, Lording T, Monk AP, Parker D, Lustig S. Robotic assessment of patella tracking in total knee arthroplasty. J ISAKOS. 2024 Oct;9(5):100287. doi: 10.1016/j.jisako.2024.06.006. Epub 2024 Jun 21. PMID: 38909904.