Proximal fibular osteotomy: a new surgery for pain relief and improvement of joint function in patients with knee osteoarthritis

Wang, Xiaohu; Wei, Lei; Lv, Zhi; Zhao, Bin; Duan, Zhiqing; Wu, Wenjin; Zhang, Bin; Wei, Xiaochun

doi:10.1177/0300060516676630

Cited by 86 publications

(125 citation statements)

References 8 publications

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“…). 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. The application of this procedure in treating medial compartment knee OA was rationalized by the theory of non‐uniform settlement of the tibial plateau, which contains two essential initiatives that work synergistically to exacerbate the varus deformity of the tibia: osteoporosis of the proximal tibia and lateral support provided by the fibula–soft tissue complex.…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…Wang et al [24] reported results on 46 patients who had undergone PFO with a follow-up of 12 months. No postoperative complications were found, and the duration of the procedure lasted 32 ± 9 min.…”

Section: Discussionmentioning

confidence: 99%

“…It was found in clinical studies of PFO that varus deformity improved following PFO [18,19,24]. When the continuity of the fibula is interrupted, the loads borne by the lateral column of the proximal tibia increases resulting in "settling" on the lateral side [21,24] (Fig.…”

Section: The Concept Of Non-uniform Settlementmentioning

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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“…Our group established the non‐uniform settlement theory by researching anatomy, radiology, biomechanics, and clinic. We proposed osteoporosis was the initial factor for causing force change.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Change of Lumbar Structure and Associated Factors: A Retrospective Study

Wei

Zhu

Zhao

et al. 2019

Orthopaedic Surgery

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Objective: To determine whether lumbar anatomy parameters are in dynamic change and related factors.Methods: This is a retrospective study. Participants who did lumbar computed tomography (CT) scanning in Shandong University Qilu Hospital from October 2017 to March 2019 were selected. The 476 participants were randomly selected as male or female, with the age ranging from 17 to 87 years (mean, 55.19; standard deviation, 14.28 years). All the measurements were taken based on the CT scanning image and the measurement of lumbar morphology was conducted using picture archiving and communication systems (PACS). The angle between the horizontal alignment and pedicle center on median sagittal view, the angle between upper endplate and lower endplate on median sagittal view as well as transverse section angle (TSA) using Magerl point in the axial view was determined by reconstructive CT analysis.Results: In the overall participants, the angle between the horizontal alignment and pedicle center on median sagittal view of lumbar one to three was significantly decreased with aging, from 3.90 AE 2.81 to −4.18 AE 6.86 (P = 0.002), 5.60 AE 2.89 to −4.14 AE 5.90 (P = 0.030), and 4.75 AE 2.95 to −2.87 AE 4.68 (P < 0.001), respectively. Additionally, the angle between the horizontal alignment and pedicle center on median sagittal view in male participants of lumbar two was dramatically decreased, from 4.83 AE 2.79 to −4.45 AE 5.97 (P = 0.30). And that of lumbar three in female participants was significantly decreased, from 4.56 AE 2.52 to −2.88 AE 5.03 (P = 0.029). Furthermore, of the overall participants, the angle between upper endplate and lower endplate on median sagittal view of lumbar one to four was associated with aging (P < 0.001, P < 0.001, P = 0.015, P < 0.001, respectively). The angle of lumbar one, two and four in male participants and lumbar one to four in female participants were all significantly related to aging (all P < 0.05). Moreover, in the participants overall, the TSA of lumbar one to three was significantly associated with aging (P = 0.015, P = 0.006 and P = 0.007, respectively). In addition, this angle in lumbar one to lumbar four in male participants were all negatively associated with aging (P = 0.017, P = 0.001, P = 0.005 and P = 0.036, respectively). Conclusion:Lumbar anatomy parameters are in dynamic change in an age and gender dependent manner. During spine surgery in elderly patients, more attention should be paid to these anatomic changes.

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Proximal fibular osteotomy: a new surgery for pain relief and improvement of joint function in patients with knee osteoarthritis

Cited by 86 publications

References 8 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

Dynamic Change of Lumbar Structure and Associated Factors: A Retrospective Study

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