Proximal fibular osteotomy relieves pain in spontaneous osteonecrosis of the knee: A retrospective study

Abstract

Spontaneous osteonecrosis of the knee (SONK) causes knee pain and joint motion limitation. Ischemia or insufficiency fracture may be the cause, but no consensus has been developed. Proximal fibular osteotomy (PFO) has been reported to relieve pain from osteoarthritis through medial compartment decompression. We reviewed the effect of this procedure on medial compartment SONK patients and explored clinical and radiological results.Since January 2018 to January 2020, the data of 12 knees (8 right and 4 left) from 11 SONK patients (9 women and 2 men) who received PFO were analyzed. The average age was 61.5 years. The diagnosis of SONK was established through weight-bearing anterior-posterior radiographs or magnetic resonance imaging (MRI). Visual analog scale (VAS) scores, Oxford knee score (OKS), Femorotibial angle (FTA), medial joint space, and lateral joint space were documented preoperatively and at follow up visits. Outcome assessment for the clinical and radiographic data was reviewed at 12-and 24-month follow-up visits.The mean follow up period was 33 months. All patients were able to walk with or without cane assistance the day after surgery. Both VAS score and OKS (preoperative: 6.6 ± 0.9 and 24.7 ± 3.8, respectively) improved significantly at the 12-month follow-up, and to 24-month follow-up (3.6 ± 1.3 and 35.6 ± 4.5, respectively, P < .05). Medial joint space ratio increased from 0.36 to 0.50 (P < .05). Changes of FTA were insignificant at any point of follow up. Four patients underwent follow-up MRI, and a decrease in the osteonecrotic area was clearly observed in 2 patients.By achieving medial knee decompression, PFO allowed quick weight-bearing recovery, pain relief, and improvement in knee function in SONK patients.Abbreviations: BMI = body mass index, FTA = femoral tibial angle, HTO = high tibial osteotomy, KSS = knee society score, MRI = magnetic resonance imaging, OA = osteoarthritis, OKS = Oxford knee score, PFO = proximal fibular osteotomy, ROM = range of motion, SIFK = subchondral insufficiency fractures of the knee, SONK = spontaneous osteonecrosis of the knee, TKA = total knee arthroplasty, UKA = unicompartmental knee arthroplasty, VAS = visual analog scale.

Evaluation of the effect of vascularized fibula graft harvesting on coronal plane alignment and functional outcomes of the lower limb

“…Proximal osteotomy is particularly likely to produce biomechanical changes due to its close proximity to the tibiofibular joint. There are studies evaluating the change in the HKA after proximal fibular osteotomy, and the change in our study was similar to that reported in the literature (the change in the HKA is less than 5 degrees) 22 , 27 , 28 . In our study, changes in the alignment of the coronal plane of both the ankle and knee joints after fibula osteotomy and excision were evaluated.…”

Subchondral insufficiency fracture of the medial femoral condyle treated conservatively with early non-weightbearing

“…Jauregui et al [ 21 ] conducted a meta-analysis of the studies about unicompartmental knee arthroplasty for SONK and concluded that it could be as effective as the total knee replacement, which is the most preferred choice of treatment for late stages. Other surgical options include high tibial osteotomy [ 22 ], knee arthroscopy for either diagnostic reasons or for addressing a possible meniscal root tear, proximal fibula osteotomy [ 23 ] and osteochondral allograft transplantation [ 24 ].…”

Спонтанды Тізе Остеонекроздың Диагностикалау Мен Емдеудің Заманауи Көзқарастары

“…Снижение остеонекротической области наблюдалось у 2 пациентов (средний период наблюдения=33 месяца). Данный метод позволил облегчить боль и улучшить функциональность коленного сустава [37]. Главным осложнением, связанным с ПФО, является повреждение общего или поверхностного перонеального нерва, вызывающее временное онемение голени.…”