Proximal Fibular Osteotomy for Medial Compartment Knee Osteoarthritis: Is It Worth?

Huda, Najmul; Islam, Mir Shahid Ul; Kumar, Hemant; Pant, Ajay; Bishnoi, Sandeep

doi:10.1007/s43465-020-00160-0

Cited by 10 publications

(18 citation statements)

References 17 publications

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“…They have also reported reversible weakness in the leg in 16 (14.5) knees but not specified EHL. Huda N et al [13] mentioned paraesthesia in nine knees (16%) out of 56 but no EHL weakness. Prakash et al [6] reported foot drop in one (1.1%) patient, EHL weakness in 8 (9%) patients and paraesthesia in seven (8%) patients.…”

Section: Discussionmentioning

confidence: 96%

“…All scores were remained almost the same from 3 months post-operative period to the final follow-up. Recently, Huda et al [13] published a prospective study from India on 56 knees with medial compartmental osteoarthritis knee and they assessed the outcome of PFO with VAS and WOMAC scoring system and radiologically with FTA. They found a significantly improved score at 3 months except for FTA.…”

Section: Discussionmentioning

confidence: 99%

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

Sabir

Faizan

Singh

et al. 2020

IJOO

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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.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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

Sabir

Faizan

Singh

et al. 2020

IJOO

View full text Add to dashboard Cite

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“…Most previous studies of PFO to treat KOA focus on the clinical outcomes and radiographic analysis rather than biomechanics [ 8 – 10 ]. PFO was reported to significantly improve patients' knee function as well as pain evidenced by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), American Knee Society Score (KSS), and hospital for special surgery score [ 10 – 13 ]. The radiographic results show that the hip-knee-ankle (HKA) angle and femorotibial angle are corrected, and the medial space of the knee joint increased on average after PFO [ 3 , 10 , 12 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Most previous studies of PFO to treat KOA focus on the clinical outcomes and radiographic analysis rather than biomechanics [8][9][10]. PFO was reported to significantly improve patients' knee function as well as pain evidenced by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), American Knee Society Score (KSS), and hospital for special surgery score [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Gait Improvement in Patients with Knee Osteoarthritis after Proximal Fibular Osteotomy

Cao

et al. 2022

BioMed Research International

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Proximal fibula osteotomy (PFO) is a relatively new surgery to treat medial compartment knee osteoarthritis (KOA), which can improve varum deformity and relieve knee joint pain. However, the gait alterations in KOA patients after PFO are still poorly understood. The purpose of this study was to evaluate the gait patterns change in patients of medial compartment KOA after PFO. Gait data were collected for 9 females with unilateral medial compartment KOA before and at 6 months after PFO and also for 9 healthy age-matched females. Paired t -test was used to determine the effect of PFO within the KOA group, and independent t -test were performed to compare between KOA and control groups for spatiotemporal, kinematic, and kinetic variables. The results showed that patients with KOA had significantly increased knee peak flexion angle, knee sagittal range of motion, and peak external hip adduction moment but decreased knee frontal range of motion in the affected limb after PFO. The gait symmetry was improved postoperatively confirmed by single support and swing phases, knee peak flexion angle and sagittal range of motion, peak external hip and knee adduction moments, and peak anterior and peak posterior ground reaction forces. These findings provided evidence of a biomechanical benefit and gait improvement following PFO to treat medial compartment KOA.

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“…Improvement in the knee and functional subsets of the AKSS as reported by us have been reported by other studies also [ 7 , 9 ]. Some studies have reported improvements in Oxford Knee Scores [ 10 , 8 , 18 , 19 ]. In our study, the clinical and functional AKSS improved from 56.49 ±6.95 to 72.71 ±9.87 and 48.24 ±14.31 to 71.46 ±15.18 respectively (p<0.001).…”

Section: Discussionmentioning

confidence: 99%

Proximal Fibular Osteotomy for Medial Joint Osteoarthritis of the Knee: A Prospective Cohort Study

Kumar¹,

Srivastava²,

Kumar³

et al. 2021

Cureus

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Background and objective Osteoarthritis (OA) is a polyarticular disease that most commonly afflicts the knee joint. Established operative treatment options for medial joint OA of the knee include high tibial osteotomy, unicompartmental knee arthroplasty, and total knee arthroplasty. Proximal fibular osteotomy (PFO) is a relatively new procedure for treating medial joint OA of the knee. The objective of this study was to describe the functional and radiological outcomes at one year in patients undergoing PFO for medial joint OA of the knee. Materials and methods The study included 21 patients with medial joint OA of the knee who underwent PFO. Visual analog scale (VAS) score, medial to lateral knee joint space ratio (ML ratio), Kellgren-Lawrence (KL) grade, and the American Knee Society Score (AKSS) (clinical and functional) were recorded preoperatively. VAS score, ML ratio, and AKSS (clinical and functional) were documented again at the three-month and one-year follow-ups. Results The mean age of the patients was 58.85 ±6.94 years; 12 (57.1%) were female and nine (42.9%) were males. The mean VAS score for pain decreased from 7.86 ±0.66 at baseline to 5.14 ±1.15 at three months (p<0.001) and 3.78 ±1.26 at one year (p<0.001). The mean clinical AKSS was 56.49 ±6.95 at baseline, which increased to 63.41 ±6.20 at three months (p<0.001) and 72.71 ±9.87 at one year (p<0.001). The mean functional AKSS at baseline was 48.24 ±14.31, which increased to 60.10 ±14.81 at three months (p<0.001) and 71.46 ±15.18 at one year (p<0.001). The mean ML ratio at baseline was 0.33 ±0.19, which increased to 0.41 ±0.20 at three months (p<0.01) and 0.51 ±0.22 at one year (p<0.001). Conclusion In patients who undergo PFO for OA of the knee, improvements in VAS score for pain, AKSS (functional and clinical), and ML ratio were observed to be maintained for a period of one year postoperatively.

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Proximal Fibular Osteotomy for Medial Compartment Knee Osteoarthritis: Is It Worth?

Cited by 10 publications

References 17 publications

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

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

Gait Improvement in Patients with Knee Osteoarthritis after Proximal Fibular Osteotomy

Proximal Fibular Osteotomy for Medial Joint Osteoarthritis of the Knee: A Prospective Cohort Study

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