Mechanism and influencing factors of proximal fibular osteotomy for treatment of medial compartment knee osteoarthritis: A prospective study

Qin, Di; Chen, Wei; Juan, Wang; Lv, Hongzhi; Ma, Wenhui; Dong, Tieli; Zhang, Yingze

doi:10.1177/0300060518772715

Cited by 51 publications

(42 citation statements)

References 20 publications

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“…Compared to the lateral wedge insole, the proximal partial fibulectomy could allow more ankle eversion without increasing fibular loading, because of higher mobility of the distal fibula. Distal migration of the fibula head after proximal partial fibulectomy was revealed in our previous study. Besides this change, talar tilt and proximal migration of the lateral malleolus, as well as significant reduction of load through the distal fibular remnant have been reported after partial fibulectomy.…”

Section: Discussionmentioning

confidence: 64%

“…Our clinical and radiological follow‐up showed decreased mean femorotibial angle (FTA), lateral joint space, and mean visual analog scale (VAS) score, as well as improved American Knee Society Score (KSS) and Hospital for Special Surgery (HSS) knee score, indicating that proximal fibular osteotomy can significantly improve both the radiographic appearance and the function of the affected knee joint, and also achieve long‐term pain relief (Fig. ). Recent published studies have consistently reported improvements in pain and function, as well as re‐adjustment of knee biomechanics and kinematics after proximal partial fibulectomy.…”

Section: Introductionmentioning

confidence: 61%

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Anatomical Adaptation of Fibula and its Mechanism of Proximal Partial Fibulectomy Associated with Medial Compartment Knee Osteoarthritis

Juan

Chen

et al. 2019

Orthopaedic Surgery

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Objectives To reveal the anatomical adaptation of the fibula and its relations to age and settlement of the medial tibial plateau, and to explore the mechanism of proximal partial fibulectomy in treating medial compartment knee osteoarthritis (OA). Methods A retrospective study was performed in the Third Hospital of Hebei Medical University. Weight‐bearing full‐leg anteroposterior (AP) radiographs of 280 adults (560 knees) obtained from 1 January 2018 to 31 October 2018 were enrolled according to our inclusion and exclusion criteria, including 157 men and 123 women, with an average age of 50.3 ± 14.8 years (range, 19–80 years). Radiographic severity of knee OA was assessed using Kellgren and Lawrence (K–L) grading. The settlement of the medial tibial plateau was evaluated using the medial proximal tibial angle (MPTA). Curvatures of the tibia and the fibula were measured as proximal tibial curvature (PTC), distal tibial curvature (DTC), proximal fibular curvature (PFC), and distal fibular curvature (DFC). Two orthopaedic surgeons performed all the radiological measurements for 30 randomly selected patients, and repeated the measurements 1 week later. Based on the satisfactory intra‐observer and inter‐observer reliabilities (ICC > 0.9), each parameter was analyzed in this study. Multivariable linear regression models were used to examine relations between radiological measurements and age. Results The mean MPTA, PTC, DTC, PFC, and DFC were 85.4° ± 2.8°, 176.2° ± 1.9°, 176.8° ± 1.8°, 176.8° ± 1.9°, and 177.0° ± 2.0°, respectively. Ninety‐three knees of K–L grade I were categorized as non‐knee OA, and 467 knees of K–L grades II–IV were categorized as knee OA. The MPTA, PTC, and PFC of the knee OA group were significantly smaller than those of non‐knee OA group (P < 0.05). The K–L grade of knee OA significantly increased with age (χ 2 = 182.169, P < 0.01). The multivariate linear regression analysis indicated that the MPTA and fibular curvatures were negatively correlated with age (the regression equation is age = 561.165–0.945 MPTA‐0.937 PFC‐0.959 DFC, P < 0.05), and the MPTA was negatively correlated with PFC (the regression equation is MPTA = 7.827 + 0.099 DFC, P < 0.05). Conclusions The proximal curve of the fibula increased in patients with medial compartment knee OA, and this change was positively correlated with age and settlement of the medial tibial plateau. This anatomical adaptation of the fibula was associated with greater fibular axial load and the pulling from the peroneus longus. The proximal partial fibulectomy procedure effected a receptive foot pronation to reduce KAM and rebalance the biceps‐proximal fibula–peroneus longus complex, consequently achieving medial compartment unloading.

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 61%

Anatomical Adaptation of Fibula and its Mechanism of Proximal Partial Fibulectomy Associated with Medial Compartment Knee Osteoarthritis

Juan

Chen

et al. 2019

Orthopaedic Surgery

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“…Radiographs at 1 year showed increased valgus of the knee and improvement in the medial joint space in reports by multiple authors [21,27]. The mechanism by which these changes occur following a PFO is not clear but the theories have been previously discussed.…”

Section: Discussionmentioning

confidence: 96%

“…Qin et al [27] in their prospective study of 67 PFOs found that significant clinical improvement after surgery was proportional to the amount of distalization of the fibula and the inclination angle of the proximal tibiofibular joint. The authors conceptualise that after PFO, the proximal fibula was no longer subject to compressive forces of weight transmission from the distal fibula.…”

Section: Dynamic Fibular Distalization Theorymentioning

confidence: 99%

Proximal fibular osteotomy in the treatment of medial osteoarthritis of the knee – A narrative review of literature

Shanmugasundaram¹,

Kambhampati²,

Saseendar

2019

Knee Surg & Relat Res

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Proximal fibular osteotomy has been proposed as a simple and inexpensive alternative to high-tibial osteotomy and unicondylar knee arthroplasty and may be useful for low-income populations that cannot afford expensive treatment methods. However, there is no consensus existing regarding the mechanism by which it acts nor the outcome of this procedure. This study was performed to analyze the available evidence on the benefits of proximal fibular osteotomy and to understand the possible mechanisms in play. There are various mechanisms that are proposed to individually or collectively contribute to the outcomes of this procedure, and include the theory of non-uniform settlement, the too-many cortices theory, slippage phenomenon, the concept of competition of muscles, dynamic fibular distalization theory and ground reaction vector readjustment theory. The mechanisms have been discussed and future directions in research have been proposed. The current literature, which mostly consists of case series, suggests the usefulness of the procedure in decreasing varus deformity as well as improving symptoms in medial osteoarthritis. However, large randomised controlled trials with long-term follow-up are required to establish the benefits of this procedure over other established treatment methods.

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“…In addition, problems associated with HTO can be a serious problem that has an impact on the occurrence of events and TKR can be done efficiently without worrying about the occurrence. [4][5][6] Hence; under the light of above mentioned data, the present study was undertaken for assessing the functional outcomes of proximal fibular osteotomy in osteoarthritis knee.…”

Section: Introductionmentioning

confidence: 99%

To Study the Functional Outcomes of Proximal Fibular Osteotomy in Osteoarthritis Kee

Verma¹,

Agrawal²

2020

IJCMR

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Introduction: Knee osteoarthritis (OA), also known as degenerative joint disease, is typically the result of wear and tear and progressive loss of articular cartilage leading to radiologically decreased joint space. Proximal fibular osteotomy (PFO) is an alternative treatment to high tibial osteotomy (HTO). Hence; under the light of above mentioned data, the present study was undertaken for assessing the functional outcomes of proximal fibular osteotomy in osteoarthritis knee. Material and methods:A total of 10 patients with OA of knee were enrolled in the present study. The patients were placed in the supine position after administration of spinal anaesthesia. An approximately 5-cm longitudinal incision was made over the lateral aspect of the proximal fibula, and the fibula exposed between the peroneus muscle and soleus muscle. PFO was performed under the hands of skilled and experienced orthopaedic surgeon. Knee pain was assessed using a Visual analogue scale. Knee ambulation activities were recorded using the knee and function subscores of the American Knee Society score (KSS). All the results were recorded in Microsoft excel sheet and were analyzed by SPSS software. Chi-square test and Mann Whitney U test were used for assessment of level of significance. Results:Mean KSS score at pre-operative, postoperative, postoperative 6 weeks and postoperative 9 months were found to be 44.03, 53.50, 58.60 and 68.14 respectively. Significant results were obtained while comparing the mean KSS at different postoperative time intervals. In the present study, mean VAS score at pre-operative, postoperative, postoperative 6 weeks and postoperative 9 months were found to be 8.77, 6.96, 4.36 and 2.52 respectively. Significant results were obtained while comparing the mean VAS at different postoperative time intervals.Conclusion: PFO is a novel alternative method in the management of medial compartment arthritis of the knee.

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Mechanism and influencing factors of proximal fibular osteotomy for treatment of medial compartment knee osteoarthritis: A prospective study

Cited by 51 publications

References 20 publications

Anatomical Adaptation of Fibula and its Mechanism of Proximal Partial Fibulectomy Associated with Medial Compartment Knee Osteoarthritis

Anatomical Adaptation of Fibula and its Mechanism of Proximal Partial Fibulectomy Associated with Medial Compartment Knee Osteoarthritis

Proximal fibular osteotomy in the treatment of medial osteoarthritis of the knee – A narrative review of literature

To Study the Functional Outcomes of Proximal Fibular Osteotomy in Osteoarthritis Kee

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