Effects of proximal fibular osteotomy on stress changes in mild knee osteoarthritis with varus deformity: a finite element analysis

Pan, Deng; Lin, Tao; Yang, Peng; Xu, Jingjing; Li, Hongzhu; HeRan, Zhao; Zhang, Qingwen; Chen, Leilei; Chen, Zhenqiu; Wei, Qiushi; He, Wei

doi:10.1186/s13018-020-01894-1

Cited by 21 publications

(25 citation statements)

References 30 publications

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“…Eventually, the gap on the lateral side of the knee joint is reduced to offset the knee varus deformity caused by weight bearing. In recent years, there are more and more clinical reports on the treatment of KOA by PFO [ 12 , 13 ]. However, PFO as a new concept of knee preserving osteotomy is widely used in recent decades, and its efficacy and adverse reactions have not been widely verified in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Proximal fibular osteotomy versus high tibial osteotomy for treating knee osteoarthritis: a systematic review and meta-analysis

Ren

Wang

2022

J Orthop Surg Res

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Background Knee osteoarthritis (KOA) with varus alignment and medial space stenosis is a common degenerative disorder in the elderly. To reallocate the force bearing from the medial to the lateral compartment, the anti-varus osteotomy, including high tibial osteotomy (HTO) and proximal fibular osteotomy (PFO), corrects the mechanical lines of lower extremities using surgical methods, which alleviates the abrasion of medial cartilage and relieves pain. PFO is based on the “non-uniform settlement” theory. It is to cut small section of the proximal fibula, i.e., below the fibula head, which breaks the fibula and weakens its support for the lateral of the tibial plateau, lastly reduces the gap on the lateral side of the knee joint and offsets the knee varus deformity caused by weight bearing. We conducted this systematic review and meta-analysis to compare the clinical outcomes of PFO versus HTO intervention. Methods Twenty-three studies were acquired from PubMed, Embase, CNKI (China National Knowledge Infrastructure), Wanfang Database and Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed by RevMan5.3. Mean differences (MDs), odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration’s Risk of Bias Tool and Newcastle–Ottawa Scale were used to assess risk of bias. Results Twenty-three studies including 14 randomized controlled trials and 9 observational studies were assessed. The methodological quality of the trials ranged from low to high. The pooled results of the mean operation time (MD = − 38.75, 95% CI = − 45.66 to − 31.85, P < 0.00001), intraoperative bleeding (std. MD = − 4.12, 95% CI = − 5 to − 3.24, P < 0.00001), length of hospital stay (MD = − 3.77, 95% CI = − 4.98 to − 2.56, P < 0.00001) and postoperative complications (OR = 0.66, 95% CI = 0.37–1.18, P = 0.16) showed that the differences were statistically significant between the two interventions. The postoperative differences of visual analogue score (VAS) (MD = 0.15 95% CI = − 0.39 to 0.69, P = 0.58), hospital for Special Surgery knee score (HSS) (MD = − 2.68, 95% CI = − 6.30 to 0.94, P = 0.15), American knee society (AKS) score (MD = 0.04, 95% CI = − 0.69 to 0.77, P = 0.91), western Ontario and McMaster university of orthopedic index (WOMAC) (MD = 8.09, 95% CI = 2.06–14.13, P = 0.009) and femur–tibia angle (FTA) (MD = − 0.03, 95% CI = − 5.39 to 5.33, P = 0.99) were not statistically significant. Sensitivity analysis proved the stability of the pooled results and the publication bias was not apparent. Conclusions PFO and HTO have the same short-term efficacy in the treatment of KOA, but PFO can reduce the operation time, intraoperative bleeding, hospital stay and postoperative complications, which has certain advantages. Clinically, for patients with many complications and poor surgical tolerance, PFO can be preferred.

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Section: Introductionmentioning

confidence: 99%

Proximal fibular osteotomy versus high tibial osteotomy for treating knee osteoarthritis: a systematic review and meta-analysis

Ren

Wang

2022

J Orthop Surg Res

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“…Nie et al [26] used nite element analysis and observed that the load supported by the bula preoperatively is dispersed to the cortical bone of the tibial shaft postoperatively, considerably reducing the average stress on the medial tibial plateau, with part of the stress being transferred postoperatively to the posterolateral area of the femoral condyle. Pan et al [27] discovered that PFO can reduce stress in the medial compartment of the knee joint, with the stress path shifting from the anteromedial area of the femoral condyle to the posteromedial area. In patients with KOA, PFO postoperatively transfers uneven stress experienced by the knee joint, allowing the stress to be redistributed and improving the symptoms of KOA.…”

Section: Discussionmentioning

confidence: 99%

Radiological Study on Fibular Morphology in Knee Osteoarthritis

Fan,

Zhao,

Wang

et al. 2024

Preprint

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Background To explore the relationship between fibular morphology indicators and knee osteoarthritis (KOA) and the role of fibular morphology in the occurrence and development of KOA. Methods This retrospective study enrolled patients with KOA who sought treatment from Hospital A between January 2021 and October 2023. In total, 271 patients (447 knees), comprising 157 males and 124 females, with an average age of 60.11 ± 0.59 years (range from 18 to 86 years), were enrolled according to specific inclusion and exclusion criteria. Measurements of hip-knee-ankle (HKA),medial proximal tibial angle (MPTA),tital fibular curvature(TFC),proximal fibular curvature (PFC), distal fibular curvature (DFC),fibula tibia distance (FTD) and fibula tibia area (FTA) were taken. Intraobserver and interobserver reliabilities of all imaging measurements were assessed using intraclass correlation analysis, and the relationship between each indicator and KOA was analyzed using logistic regression. Results Patients with KOA exhibited significantly larger HKA and smaller MPTA than did those without KOA. The between-group differences of TFC,PTC,DFC,FTD and FTA were nonsignificant. Binary logistic regression analysis showed that HKA, MPTA, DFCand FTD was statistically significant. K–L grade was significantly positively correlated with HKA and significantly inversely correlated with MPTA. No significant difference in TFC,PTC,DFC,FTD and FTA was observed between patients with and without KOA. Ordinal logistic regression revealed that HKA,MPTA,DFC and FTD was statistically significant. MPTA、PFC and DFC was significantly greater in patients with valgus KOA than in patients with varus KOA. However, the between-group differences of TFC,FTD and FTA was nonsignificant. Binary logistic regression analysis showed that HKA and FTD were statistically significant. Conclusion Fibular morphology indicator FTD is a risk factor for the occurrence of KOA, the severity of KOA, and varus KOA, and DFC serves as a protective factor against the occurrence and severity of KOA.

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“…Pan et al, using computerized tomography (CT) and magnetic resonance imaging (MRI) for a finite element model, concluded that PFO could reduce stress in the medial compartment of the knee joint by transferring the stress pathway from the anterior medial area to posterior medial area on the tibial plateau . 18 In addition, an analysis of a three-dimensional gait study demonstrated that PFO could be beneficial in delaying the progression of knee OA. 19 It can also rebalance the soft tissue around the knee.…”

Section: Discussionmentioning

confidence: 99%

Combine Approach of Proximal Fibula Osteotomy (PFO) Followed by Intra-Articular Dextrose Prolotherapy in Severe Medial Knee Osteoarthritis

Rahman¹,

Herman²,

Kriswanto³

et al. 2022

JPR

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Background Knee osteoarthritis (OA) is a chronic and progressive degenerative disease. It resulted from mechanical and chemical disorders that damage the joint and the underlying bone. The management of knee OA is challenging due to poor self-regeneration of connective tissues. Surgical treatment with prolotherapy approaches was conducted to treat medial compartment knee OA. Aim To know the injection frequency to reach a 50% improvement in VAS score and WOMAC index. Methods Six patients who suffered from late-stage medial compartment knee OA underwent PFO followed by twelve sessions of intra-articular dextrose prolotherapy. The subjective pain score, visual analog scale (VAS), was assessed based on the patient subjectiveness before and after treatment. Patients marked the score from 0 to 10 cm to describe the current pain state. The functional index, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index used to evaluate the Patient’s clinical symptoms. It ranges from 0 to 96 points consisting of three main sections: pain (total 20 points), stiffness (total: eight points), and physical function disability (total 68 points). Higher scores indicate severe symptoms and function. Results Four patients showed pain relief and functional improvement with more than 50% scores of VAS and WOMAC after the treatment. Two patients received more than twelve doses of intra-articular dextrose prolotherapy due to a lack of progress. Conclusion This study provides clinical evidence for a new treatment strategy for advanced knee OA. This combined therapy improves the patient’s daily activity function and postpones the need for total knee arthroplasty (TKA).

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Effects of proximal fibular osteotomy on stress changes in mild knee osteoarthritis with varus deformity: a finite element analysis

Cited by 21 publications

References 30 publications

Proximal fibular osteotomy versus high tibial osteotomy for treating knee osteoarthritis: a systematic review and meta-analysis

Proximal fibular osteotomy versus high tibial osteotomy for treating knee osteoarthritis: a systematic review and meta-analysis

Radiological Study on Fibular Morphology in Knee Osteoarthritis

Combine Approach of Proximal Fibula Osteotomy (PFO) Followed by Intra-Articular Dextrose Prolotherapy in Severe Medial Knee Osteoarthritis

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