Proximal Fibular Osteotomy: Is it Really an Option for Medial Compartmental Osteoarthritis Knee? Our Experience at Tertiary Centre

Abstract

Introduction The medial compartment is commonly involved in age-related osteoarthritis knee because weight-bearing axis passes close to the medial condyle and its large surface area. Various treatments have been proposed ranging from conservative to total knee arthroplasty which is an expensive and complex treatment. Recently, proximal fibular osteotomy (PFO) for medial compartment knee osteoarthritis became popular as a treatment modality. Although, the mechanism of PFO is not clear. So, we conducted a prospective study to assess the clinico-radiological outcome of proximal fibular osteotomy in medial compartment osteoarthritis knee. Materials and methodsWe conducted a prospective study from November 2017 to November 2019 on 32 (47 knees) patients with degenerative medial compartmental osteoarthritis knee, varus deformity < 15 and Kellgren and Lawrence grade II and grade III (K-L Grade). We recorded the visual analogue score (VAS) and knee society score (KSS) pre-operatively and post-operatively of all patients. We got weight bearing anterio-posterior and lateral radiograph of knee done. We assessed joint space ratio and lateral tibio-femoral angle (FTA) pre-operatively, post-operatively and at each follow-up. Results Mean age was 48.4 (35-65) years and the mean follow-up was 18 months. Mean duration for unilateral PFO was 37 min and for bilateral, 55 min. The VAS was improved from 7.33 ± 0.72 to 7.13 ± 1.64 at 3 months and remained the same at final follow-up (p > 0.05). The mean pre-operative clinical and functional KSS was statistical insignificantly improved at 3 months and final follow-up (p > 0.05). The mean pre-operative lateral and mean pre-operative joint space ratio was also improved statistically insignificant (p > 0.05). Extensor hallucis longus (EHL) weakness was documented in five knees (10.6%) and paraesthesia was documented in seven (14.8%) knees. Conclusion Although, PFO is a simple, less invasive and affordable procedure, we could not reproduce the favourable results in medial compartmental osteoarthritis knee. This procedure is also associated with reversible but noticeable complications. So, we would not consider PFO as an alternative option in the treatment of medial compartmental osteoarthritis knee.

Anterior tibial artery pseudoaneurysm as a rare technical complication after corrective fibular osteotomy: a case report

“…They also reported that 14.5% of cases with transient leg weakness recovered in 4 weeks. Even a higher rate of neuromuscular complications, such as extensor hallucis longus weakness and paraesthesia over dorsolateral foot and anterolateral aspect has been documented by some Indian researchers [ 7 , 8 ], which was comparable with our early experiences in partial fibular osteotomy based on the suggested osteotomized level (6–10 cm below the fibular head) in most literature [ 2 , 4 ].…”

A Systematic Review of the Management of Knee Osteoarthritis by Proximal Fibular Osteotomy in the Indian Population

“…In summary, these studies collectively enhance our understanding of PFO as a potential management option for knee OA in the Indian population. Overall, we included eight studies [8][9][10][11][12][13][14][15], all prospective cohort studies and interventional studies carried out at different locations in India. In each of these studies, investigations evaluated the existing evidence concerning the management of knee OA through PFO in the Indian population.…”

“…In each of these studies, investigations evaluated the existing evidence concerning the management of knee OA through PFO in the Indian population. Across the included studies [8][9][10][11][12][13][14][15], 289 participants were included and recruited patients with medial compartment OA of the knee. All the included studies [8][9][10][11][12][13][14][15] detailed the management of knee OA through PFO.…”

“…Across the included studies [8][9][10][11][12][13][14][15], 289 participants were included and recruited patients with medial compartment OA of the knee. All the included studies [8][9][10][11][12][13][14][15] detailed the management of knee OA through PFO. Among the included studies, seven studies [8][9][10][11][12][13][14] assessed VAS score, three studies [8,9,12] assessed American Knee Society Score (AKSS), six studies assessed [8][9][10][11][12]14] FTA, one study [14] assessed KSS, and another one study [15] assessed Oxford Knee Scores (OKS).…”

“…All the included studies [8][9][10][11][12][13][14][15] detailed the management of knee OA through PFO. Among the included studies, seven studies [8][9][10][11][12][13][14] assessed VAS score, three studies [8,9,12] assessed American Knee Society Score (AKSS), six studies assessed [8][9][10][11][12]14] FTA, one study [14] assessed KSS, and another one study [15] assessed Oxford Knee Scores (OKS).…”