Evidence and mechanism by which upper partial fibulectomy improves knee biomechanics and decreases knee pain of osteoarthritis

Abstract

To investigate the change in short-term clinical outcomes and biomechanical properties of the knee in response to upper partial fibulectomy and to probe into the biomechanical mechanism underlying the clinical benefits of upper partial fibulectomy for medial compartment knee osteoarthritis (KOA). A total of 29 patients with medial compartment KOA underwent upper partial fibulectomy. Visual analog scale (VAS) pain, the hospital for special surgery knee score (HSS), hip-knee-ankle (HKA) angle (measured in the frontal plane), and flexion/extension range of motion of the knee were assessed before and up to 6 months after surgery. Patients and 20 healthy controls were evaluated by 3D gait analysis and dynamic lower limb musculoskeletal analysis. Both VAS pain and HSS score were significantly improved (p < 0.001) one day after surgery and steadily improved during the subsequent 6 months. HKA angle improved (p = 0.025) immediately and remained stable by 3 months after surgery. The decreased overall peak KAM (decreased by 11.1%) and increased HKA angle (increased by 1.80 degrees from a more varus to more neutral alignment) of affected and operated side by 6 months after surgery were observed. Muscle activity of biceps femoris caput longum of affected and operated side increased immediately and was equivalent to healthy controls by 6 months after surgery (p = 0.007). This pilot study provides biomechanical evidence of benefit from partial upper fibulectomy and indicates a plausible rationale for the improvement in clinical symptoms. Long-term clinical outcomes and precise biomechanical mechanism of partial upper fibulectomy should be further investigated. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-10, 2018.

Comparison of Clinical and Biomechanical Outcomes between Partial Fibulectomy and Drug Conservative Treatment for Medial Knee Osteoarthritis

“…At different follow-up time, we observed that the pain was significantly ameliorated after treatment of patients in both groups. This finding supports other published reports of upper partial fibulectomy for those with medial KOA [9–11]. Furthermore, the pain relief in the fibulectomy group is better than that in the drug group at different follow-up time with statistical differences.…”

“…The practicability and potential benefits of upper partial fibulectomy treating patients with medial KOA have been demonstrated by current studies [9–11]. This randomized controlled trial also showed that pain relief, function improvement, more efficient gait, more neutral alignment, and lower medial knee loading could be obtained within 1 year after fibulectomy compared with drug treatment.…”

“…This randomized controlled trial also showed that pain relief, function improvement, more efficient gait, more neutral alignment, and lower medial knee loading could be obtained within 1 year after fibulectomy compared with drug treatment. Furthermore, fibulectomy is minimally invasive with low cost and short hospital stay and scarcely produces any adverse effects [9–11]. Thus, upper partial fibulectomy represents an important treatment strategy for step therapy of KOA.…”

“…The specific methods and instruments by which we conducted pain (visual analog scale (VAS) pain score) and physical function (Hospital for Special Surgery knee score and passive flexion/extension range of motion) assessment, limb alignment (hip-knee-ankle (HKA) angle) measurement (measuring on long-limb radiograph), and 3D gait analysis could be seen in our previous research [10, 11].…”

“…A recently proposed new surgery, upper partial fibulectomy, has been preliminarily proved to have the efficacy for pain alleviation and improvement of the medial joint space and function in patients with medial KOA [9, 10]. Besides, our previous pilot studies further demonstrated the effectiveness of upper partial fibulectomy for patients with moderate radiographic medial KOA using clinical assessment, 3D gait analysis, finite element analysis, and dynamic lower limb musculoskeletal analysis [10, 11]. However, part of the previous researches were retrospective, had no control group, and lacked sufficient quantitative evidence, which had only low-level evidence.…”