A Combined Posterior Stable Prosthesis and Medial Condylar Sliding Osteotomy Technique for Kashin-Beck Osteoarthritis

Summary

This study evaluates a surgical technique combining a posterior-stabilized prosthesis with medial femoral condylar sliding osteotomy for Kashin–Beck disease. The approach effectively corrects knee deformities, restores function, and offers a simpler, reliable, and cost-effective alternative to constrained or hinged prostheses.

Abstract

Kashin–Beck disease (KBD) is a chronic, endemic osteoarthropathy characterized by progressive joint degeneration and deformity, frequently involving the knee and resulting in severe valgus alignment and functional impairment. Conventional surgical management of severe valgus deformities, including the use of condylar constrained knee (CCK) or hinged knee (HK) prostheses, is often associated with increased surgical trauma, higher costs, and limited accessibility, particularly in resource-constrained settings. This study evaluates a surgical technique combining posterior-stabilized (PS) total knee arthroplasty with medial femoral condylar sliding osteotomy to address severe valgus deformities in KBD. A retrospective analysis was conducted on 10 patients (11 knees) treated between 2019 and 2023. Clinical outcomes were assessed using pain scores, functional scoring systems, range of motion measurements, and radiographic evaluation of alignment and prosthesis stability. Postoperative results demonstrated significant improvements in pain, knee function, and activity levels, along with restoration of limb alignment and stable prosthesis fixation. The osteotomy site achieved satisfactory bone healing in all cases. This combined technique provides effective deformity correction and joint stabilization while reducing the need for highly constrained implants, offering a simpler, reliable, and cost-effective alternative for managing KBD-associated knee deformities.

Introduction

Kashin-Beck disease (KBD) is a regionally distributed endemic osteoarthropathy characterized by multiple symmetric degeneration and necrosis of epiphyseal, growth plate, and articular cartilage during skeletal development, followed by secondary degenerative joint disease. This condition commonly affects multiple joints systemically, with particularly prominent involvement of the knee and ankle joints¹. In China, KBD exhibits a unique belt-like geographical distribution extending from Heilongjiang Province in the northeast to Sichuan and Tibet in the southwest. According to the latest systematic review data, there was a negative correlation betw....

Protocol

This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and was approved by the Medical Ethics Committee of Xianyang Central Hospital (Approval No. 2022-IRB-02). Written informed consent was obtained from all participants prior to their inclusion in the study.

Clinical data

This retrospective study included 10 patients (11 knees with valgus deformity) treated for valgus knee deformity related to KBD at the Department of Sports Medicine and Joint Surgery between November 2019 and December 2023. The cohort comprised 6 male and 5 female patients, with....

Results

Comparison of knee pain scores

Preoperative scores on VAS and WOMAC were 7.55 ± 0.93 and 71.09 ± 7.13, respectively. Postoperative scores improved to 1.18 ± 0.40 and 7.09 ± 3.24, respectively. A paired t-test revealed that these improvements were statistically significant (p < 0.01; Table 1).

Knee joint functional score comparisons

Preoperative scores were as follows: KSS-clin.......

Discussion

The primary objectives of TKA are to restore lower-limb mechanical alignment and achieve balanced medial-lateral soft-tissue tension. However, achieving these goals is particularly challenging in patients with Krackow type II valgus deformities exceeding 20°. Excessive soft tissue release can lead to postoperative instability, necessitating constrained or hinged prostheses, which are associated with increased wear rates, shorter longevity, and compromised proprioception. Pang et al.⁸ showed t.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Knee Prosthesis – Femoral Condyle	Beijing Lidakang Technology Co., Ltd.	50120P	Model: RY A201; Material: CoCr
Knee Prosthesis – Tibial Tray	Beijing Lidakang Technology Co., Ltd.	50130	Model: RY B401; Material: CoCr + Ti
Knee Prosthesis – Tibial Insert	Beijing Lidakang Technology Co., Ltd.	50140P-9	Model: RY C401; Material: PE
Bone Cement (PALACOS R+G)	Heraeus Medical GmbH	LOT 76171594	Material: Polymethyl methacrylate (PMMA)
Metal Bone Screw (Cortical)	Tianjin Zhengtian Medical Equipment Co., Ltd.	T500035028	Model: HA004; Material: T (Material Code)
Disposable Sterile Injection Needle (C)	Zhejiang Kangkang Medical Devices Co., Ltd.	230715	Model: 1.2×32TWLB; Material: Not stated
SPSS 21.0 statistical software	IBM Corp	Version 21.0	Used for statistical analysis