The Long-term Efficacy of Total Knee Arthroplasty on End-stage Kashin–Beck Disease of the Knee in Highland Tibetan Areas Patients: A Retrospective Study with 10-Year Follow-up

Abstract

Objective: Despite the established success of total knee arthroplasty (TKA) with end-stage osteoarthritis, there is a notable scarcity of research on its long-term outcomes in individuals suffering from end-stage Kashin–Beck disease (KBD). This retrospective study aimed to assess the long-term outcomes and effectiveness of clinical function, quality of life, and complications of TKA and end-stage KBD patients in Tibetan highland areas.

Methods: The retrospective cohort included 43 KBD patients, comprising a total of 59 knees, who had undergone TKA at West China Hospital, Sichuan University between 2008 and 2021. Patients were subsequently followed up for a minimum of 3 years, and received rigorous radiological and clinical assessments at 3, 6, and 12 months post surgery, followed by annual examinations thereafter. The evaluation included various efficacy indices, including visual analogue scale (VAS) scores, hospital for special surgery (HSS) scores, functional score for adult Tibetans with Kashin–Beck disease (FSAT-KBD), and radiographic findings. Comparison of indicators within the same group was conducted using one-way repeated-measures analysis of variance or paired sample t-tests, whereas between-group differences were compared using an independent t-test.

Results: Throughout the average follow-up duration of 10.8 years, patients experienced a substantial reduction in knee pain and noteworthy functional improvement. The VAS scores decreased significantly from 77.47 ± 4.12 mm before surgery to 10.91 ± 1.97 mm after surgery, indicating considerable alleviation of knee pain. The HSS scores improved markedly, increasing from 44.26 ± 4.95 preoperatively to 91.26 ± 4.37, indicating enhanced joint function. Similarly, the FSAT-KBD exhibited positive progression, increasing from 25.90 ± 3.12 to 36.95 ± 3.54. Importantly, at the last follow-up, none of the patients presented with periprosthetic infection, prosthesis loosening, or periprosthetic fracture.

Conclusion: At long-term follow-up, compared with patients in the preoperative period, patients in Tibetan highland areas with KBD of the knee who underwent TKA benefited from a significant reduction in pain, improvement in joint function, and satisfactory improvement in quality of life.

Keywords

Kashin–Beck disease / Total knee arthroplasty / Retrospective study / Long-term results / Tibetan highland areas

References

[1] SokoloffL. The history of Kashin-Beck disease. N Y State J Med. 1989;89(6):343–351.

[2] GaoZQ, GuoX, DuanC, Ma W, XuP, WangW, et al. Altered aggrecan synthesis and collagen expression profiles in chondrocytes from patients with Kashin-Beck disease and osteoarthritis. J Int Med Res. 2012;40(4):1325–1334.

[3] SchepmanK, Engelbert RHH, VisserMM, YuC, de VosR. Kashin Beck disease: more than just osteoarthrosis: a cross-sectional study regarding the influence of body function-structures and activities on level of participation. Int Orthop. 2011;35(5):767–776.

[4] HinsenkampM, Ryppens F, BegauxF, MathieuF, de Maertelaer V, LepeireM, et al. The anatomical distribution of radiological abnormalities in Kashin-Beck disease in Tibet. Int Orthop. 2001;25(3):142–146.

[5] LiY, ZhouZ, ShenB, Yang J, KangP, YangX, et al. Clinical features of Kashin-Beck disease in adults younger than 50 years of age during a low incidence period: severe elbow and knee lesions. Clin Rheumatol. 2013;32(3):317–324.

[6] ZhouZK, ShenB, PeiFX, Kang P, LiJ, YangJ. Relation between affected big joints and classification of Kashin-Beck disease in adults of Tibetan. Chin J Bone Jt Surg. 2009;2(5):352–356.

[7] ZouK, LiuG, WuT, DuL. Selenium for preventing Kashin-Beck osteoarthropathy in children: a meta-analysis. Osteoarthr Cartil. 2009;17(2):144–151.

[8] JirongY, HuiyunP, ZhongzheY, Birong D, WeiminL, MingY, et al. Sodium selenite for treatment of Kashin-Beck disease in children: a systematic review of randomised controlled trials. Osteoarthr Cartil. 2012;20(7):605–613.

[9] GuoX, MaWJ, ZhangF, Ren FL, QuCJ, LammiMJ. Recent advances in the research of an endemic osteochondropathy in China: Kashin-Beck disease. Osteoarthr Cartil. 2014;22(11):1774–1783.

[10] CaoJ, LiS, ShiZ, YueY, SunJ, ChenJ, et al. Articular cartilage metabolism in patients with Kashin-Beck disease: an endemic osteoarthropathy in China. Osteoarthr Cartil. 2008;16(6):680–688.

[11] TangX, ZhouZ, ShenB, Yang J, KangP, LiJ, et al. Serum levels of TNF-α, IL-1β, COMP, and CTX-II in patients with Kashin-Beck disease in Sichuan. China Rheumatol Int. 2012;32(11):3503–3509.

[12] LuoR, LiuG, LiuW, PeiF, ZhouZ, Li J, et al. Efficacy of celecoxib, meloxicam and paracetamol in elderly Kashin-Beck disease (KBD) patients. Int Orthop. 2011;35(9):1409–1414.

[13] BjordalJM, Ljunggren AE, KlovningA, SlørdalL. Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials. BMJ. 2004;329(7478):1317.

[14] TangX, ZhouZK, ShenB, Kang PD, YangJ, LiJ, et al. Total knee arthroplasty in elderly patients with severe Kashin-Beck disease of the knee. Int Orthop. 2014;38(4):753–759.

[15] CarrAJ, Robertsson O, GravesS, PriceAJ, ArdenNK, JudgeA, et al. Knee replacement. Lancet. 2012;379(9823):1331–1340.

[16] StrohDA, Delanois R, NaziriO, JohnsonA, MontM. Total knee arthroplasty in patients over 80 years of age. J Knee Surg. 2011;24(4):279–283.

[17] HamelMB, TothM, LegedzaA, Rosen MP. Joint replacement surgery in elderly patients with severe osteoarthritis of the hip or knee: decision making, postoperative recovery, and clinical outcomes. Arch Intern Med. 2008;168(13):1430–1440.

[18] ZhangL, LiH, BaiL, JiN. Patients with Kashin-Beck disease obtained lower functional activities but better satisfaction than patients with osteoarthritis after Total knee arthroplasty: a retrospective study. Clin Interv Aging. 2022;17:1657–1662.

[19] LiuHM, WangYF, WuJM, LiBY, DongF, Lu DF, et al. A comparative study of clinical effect of total knee arthroplasty in the treatment of primary osteoarthritis and osteoarthritis of Kashin-Beck disease. Int Orthop. 2020;44(9):1719–1726.

[20] JinZK, YangY, XuCX, YangB, LammiMJ, Chang YH, et al. Outcomes of total knee arthroplasty in the adult Kashin-Beck disease with severe osteoarthritis. Int Orthop. 2019;43:323–331.

[21] XiongG. Diagnostic, clinical and radiological characteristics of Kashin-Beck disease in Shaanxi Province, Pr China. Int Orthop. 2021;25(3):147–150.

[22] MathieuF, BegauxF, LanZY, Suetens C, HinsenkampM. Clinical manifestations of Kashin-Beck disease in Nyemo Valley, Tibet. Int Orthop. 1997;21:151–156.

[23] MarxRG, StumpTJ, JonesEC, Wickiewicz TL, WarrenRF. Development and evaluation of an activity rating scale for disorders of the knee. Am J Sports Med. 2001;29(2):213–218.

[24] QiangH, ZongkeZ, BinS, JingYANG, PengdeKANG, Xiaobo YANG, et al. The primary validation study of Kashin-Beck disease affected big joints function assessing system for adult Tibetans in Rangtang County. Chin J Evid Based Med. 2010;10(9):1041–1044.

[25] CookeTDV, SledEA, ScudamoreRA. Frontal plane knee alignment: a call for standardized measurement. J Rheumatol. 2007;34(9):1796–1801.

[26] NishidaK, Matsumoto T, TakayamaK, IshidaK, NakanoN, MatsushitaT, et al. Remaining mild varus limb alignment leads to better clinical outcome in total knee arthroplasty for varus osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2017;25(11):3488–3494.

[27] LingM, WuX, ChangY, Dong X, SunZ, LingL, et al. Staged total knee arthroplasty for bilateral complex knee deformities from Kashin–Beck disease and skeletal dysplasia. Knee. 2017;24(3):692–698.

[28] LiuFD, WangZL, HinsenkampM. Osteotomy at the knee for advanced cases of Kashin-Beck disease. Int Orthop. 1998;22(2):87–91.

[29] YangLG, GaoDL, TuZM, DongS, RenJ, XieJJ, et al. Stabilized prosthesis after total knee arthroplasty for the adult Kaschin-Beck disease with mixed deformities. Chin J Bone Joint Surg. 2012;5(3):212–216.

[30] TangX, ZhuJ, ZhouZ, Shen B, KangP, PeiF, et al. Total hip replacement in adult patients with severe Kashin-Beck disease of the hip. BMC Musculoskelet Disord. 2016;15(17):289.

[31] PasteelsJL, LiuFD, HinsenkampM, Rooze M, MathieuF, PerlmutterN. Histology of Kashin-Beck lesions. Int Orthop. 2001;25(3):151–153.

[32] ZhengJ, WuC, MaW, ZhangY, HouT, XuH, et al. Abnormal expression of chondroitin sulphate N-acetylgalactosaminyltransferase 1 and Hapln-1 in cartilage with Kashin-Beck disease and primary osteoarthritis. Int Orthop. 2013;37(10):2051–2059.

[33] MalaisseF, Haubruge E, MathieuF, BegauxF. Ethno-agricultural approach to the rural environment in the prevention of Kashin-Beck disease. Int Orthop. 2001;25(3):170–174.

[34] HuangQ, ZhouZK, MaJ, LiY, YangX, Shen B, et al. The arthropathic and functional impairment features of adult Kashin-Beck disease patients in aba Tibetan area in China. Osteoarthr Cartil. 2015;23(4):601–606.

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