Assessing the efficacy and clinical outcomes following of proximal fibular osteotomy in managing the osteoarthritis of the medial compartment of the knee: A clinical study

Abstract

Background: Knee arthritis involving the medial compartment is usually managed with PFO (Proximal Fibular Osteotomy) compared to high tibial osteotomy owing to minimal/no complications associated. PFO supports lateral tibial plateau. PFO also shifts load laterally from the medial compartment improving function and decreasing the pain. Aims: The present study was aimed to assess the efficacy of the proximal fibular osteotomy in managing knee osteoarthritis concerning joint function improvement and pain relief. Materials and Methods: In 25 subjects, following proximal fibular osteotomy, VAS (Visual analog scale) was used to assess the pain. As per American Knee Society scores, knee and function subscores were used to assess knee ambulation activities. The subjects were followed at 4, 8, and 12 weeks postoperatively. Radiographs were taken preoperatively and postoperatively to evaluate the knee joint space ratio. Based on the lower extremity radiograph, the hip-knee-ankle angle was evaluated and the results were formulated. Results: VAS scores improved significantly from 8.04±1.52 to 2.76±2.36 with a p-value of <0.0001. Mean knee scores reduced from 44.43±8.92 to 41.26±13.51, non-significantly with the p-value of 0.3325. Mean function subscores, also improved postoperatively, at 12 weeks, from 69.04±11.14 to 67.65±13.67 non-significantly with the p-value of 0.6952. Improvement was seen radiographically following PFO in 68% (n=17) of study subjects. Knee joint space ratio (medial to a lateral compartment) improved non-significantly postoperatively from 0.42±0.28 to 0.59±0.26 following Proximal Fibular Osteotomy with the p-value of 0.03. Conclusion: The present study concludes that Proximal fibular osteotomy is a fast, cost-effective, safe, and simple management strategy for knee osteoarthritis which helps in improving joint range of motion, medial joint space, and pain in the subjects with knee osteoarthritis. Also, PFO is an affordable alternative that can eliminate or delay the need for total knee replacement.