Proximal fibular osteotomy to treat medial compartment knee osteoarthritis: Preoperational factors for short-term prognosis

Abstract

ObjectiveThe purpose of this study was to determine the association between preoperational factors and patients’ short-term outcome after proximal fibular osteotomy (PFO) and to provide a basis for detailed surgical indication and patient selection.MethodsThis was a retrospective study of patients undergoing PFO between January 2015 and December 2015. Preoperational clinical data including gender, age, duration of disease, visual analogue score (VAS) and American Knee Society (KSS) score were collected. The radiological factors including hip-knee-ankle angle (HKA angle), condyle-plateau angle (CP angle), Kellgren and Lawrence grade (KL grade), joint space width of both compartments and settlement value were also considered. Patients were followed for at 12 months postoperatively. Both clinical and functional KSS scores were obtained. The outcome of interest was divided into clinical outcome and functional outcome. For each, two criteria were defined: satisfaction and significant improvement. Satisfaction is characterized by a KSS clinical or functional score over 70 points (excellent and good results); significant improvement refers to an increase in KSS scores of more than 15 points. Bivariate logistic regression for the association between preoperational factors and outcomes of interest was performed. Multivariable logistic regression analyses were used to detect the independent factors affecting the outcomes.ResultsA total of 84 patients and 111 knees were followed-up. Of these, 17 knees were from males and 94 were from females. The average age was 59.45±8.82 years. The average preoperational VAS score, KSS clinical and functional score were 7.08±1.41 points, 49.14±10.95 points and 44.97±17.71 points, respectively. According to KL grading, there were 17 knees of grade 2, 47 knees of grade 3, and 47 knees of grade 4. In clinical outcomes, there were 51 knees in the satisfaction group and 77 knees in the significant improvement group. In functional outcomes, 43 knees were in the satisfaction group and 76 knees in the significant improvement group. KSS clinical score (OR = 1.134, 95%CI = 1.067–1.205, P = 0.000) was the independent factor associated with clinical satisfaction. Age (OR = 1.072, 95%CI = 1.000–1.150, P = 0.048), VAS score (OR = 1.679, 95%CI = 1.041–2.706, P = 0.033), KSS clinical (OR = 1.072, 95%CI = 1.005–1.144, P = 0.034) and functional (OR = 1.100, 95%CI = 1.044–1.159, P = 0.000) score, HKA angle (OR = 1.345, 95%CI = 1.119–1.617, P = 0.002) and settlement value (OR = 7.540, 95%CI = 1.307–43.484, P = 0.024) were the independent factors associated with functional satisfaction. KSS clinical (OR = 0.905, 95%CI = 0.850–0.963, P = 0.002) score, CP angle (OR = 0.760, 95%CI = 0.593–0.973, P = 0.030) and medial joint space width (OR = 0.001, 95%CI = 0.000–0.107, P = 0.003) were the independent factors associated with significant clinical improvement; VAS score (OR = 1.582, 95%CI = 1.042–2.402, P = 0.031), KSS functional (OR = 0.888, 95%CI = 0.838–0.942, P = 0.000) score, HKA angle (OR = 1.292, 95%CI = 1.10...

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

“…Liu et al [30] reported on 84 patients and 111 knees who had undergone PFO with a follow-up of 1 year. This is one of the largest series reported, in terms of numbers.…”

“…Huang et al [26] advocates removing a 1-cm segment of fibula 7-8 cm from the head of the fibula by accessing it through the inter-muscular space between the extensor digitorum longus and peroneus longus/peroneus brevis, under local anesthesia. Others have used an approach between the peroneus and the soleus and removed a 2-cm segment 6-10 cm below the fibular head [20,30].…”

“…Liu et al [30] in their study determined what factors affected the outcome after PFO. They concluded that patients with a near-normal HKA angle showed better outcomes in joint function, which might be because PFO could only partially correct the varus deformity of the tibial plateau.…”

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

“…Based on previous findings, our group established the “non‐union settlement theory,” which was firstly applied in knee osteoarthritis. We found the ratio of settlement of medial tibial plateau was decreased faster than that of the fibular part.…”

“…By using this method, researchers found that the neck shaft angle of the femur and femoral neck torsion angle of the Asian population were significantly decreased, whereas acetabular anteversion angle was remarkably increased with aging. Additionally, a previous study found that, with aging, medial tibial plateau was decreased and genu varum was accelerated, accompanied by increased proximal fibular curve angle. In the occurrence and progression of degenerative osteoarthritis, the tibial plateau settlement value was increased with the upgrading of Kellgren and Lawrence grades, which is a common method of classifying the severity of knee osteoarthritis.…”