Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2024 Jun;16(6):1300-1307. doi: 10.1111/os.14068. Epub 2024 Apr 21.
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.
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.
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.
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.
尽管全膝关节置换术（TKA）治疗终末期骨关节炎已取得显著成效，但针对终末期大骨节病（KBD）患者的 TKA 长期疗效研究却相对较少。本回顾性研究旨在评估在藏区高原地区，TKA 治疗终末期 KBD 的长期临床疗效、功能结果、生活质量和并发症。
回顾性队列研究纳入了 2008 年至 2021 年在四川大学华西医院接受 TKA 的 43 例 KBD 患者，共 59 膝。患者的随访时间至少 3 年，术后 3、6、12 个月及此后每年均接受严格的影像学和临床评估。评估内容包括视觉模拟评分（VAS）、美国特种外科医院（HSS）评分、成人藏族大骨节病功能评分（FSAT-KBD）和影像学结果等多项疗效指标。采用单因素重复测量方差分析或配对样本 t 检验对同组内指标进行比较，采用独立 t 检验对组间差异进行比较。
平均随访 10.8 年期间，患者的膝关节疼痛显著减轻，功能明显改善。VAS 评分从术前的 77.47±4.12mm 显著下降至术后的 10.91±1.97mm，提示膝关节疼痛明显缓解。HSS 评分明显提高，从术前的 44.26±4.95 分提高至术后的 91.26±4.37 分，提示关节功能明显改善。FSAT-KBD 评分也呈正性进展，从术前的 25.90±3.12 分提高至术后的 36.95±3.54 分。重要的是，末次随访时，所有患者均未发生假体周围感染、假体松动或假体周围骨折。
在长期随访中，与术前相比，TKA 治疗藏区高原地区膝关节 KBD 的患者疼痛明显减轻，关节功能明显改善，生活质量明显提高。
