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

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

doi:10.1007/s43465-020-00160-0

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

Indian J Orthop. 2020 Jun 9;54(Suppl 1):47-51. doi: 10.1007/s43465-020-00160-0. eCollection 2020 Sep.

Authors

Najmul Huda¹, Mir Shahid Ul Islam¹, Hemant Kumar¹, Ajay Pant¹, Sandeep Bishnoi¹

Affiliation

¹ Department of Orthopaedics, Teerthankar Mahaveer Medical College and Research Centre Bagadpur, Uttar Pradesh, Moradabad, 244001 India.

Abstract

Background: Osteoarthritis of knee is one of the important causes of knee pain in elderly patients and is a debilitating disease. It often leads to varus deformity of knee. Many treatment options are available for this progressive knee joint disorder. Proximal fibular osteotomy (PFO) is a novel yet simple procedure used to alleviate the symptoms of medial compartment knee osteoarthritis. The present study was undertaken to evaluate whether this procedure improves the symptoms, functions and limb alignment in patients with medial compartment knee osteoarthritis.

Methods: Following approval by the Institutional Review Board, this prospective study included 42 cases (56 knees) with Kellgren-Lawrence grade II and III medial compartment knee osteoarthritis and underwent proximal fibular osteotomy. Clinical assessment was done by visual analogue scale (VAS) score and The Western Ontario and McMaster universities osteoarthritis Index (WOMAC) score pre-operatively and at 3, 6 and 12 months follow-up for pain and functional improvement. Radiological assessment was done by measuring femoro-tibial angles (FTA) pre-operatively and at 1 year follow-up.

Results: The mean age was 58.30 years. There were 30 females and 12 males. The preoperative mean WOMAC score was 87.3, at 3 months follow-up it was 29.4 this was significantly better (p < 0.05) but the improvement was not significant at subsequent follow-up visits. Similarly the VAS scores also showed significant improvement at 3 months, but not at 6 and 12 months follow-up. There was no significant improvement in the femoro-tibial angle (FTA) at 1 year follow-up.

Conclusion: The study highlights that both the VAS scores and WOMAC scores were significantly better at 3 months after surgery. However these did not show any significant improvement at 6 and 12 months. It does not change the alignment of knee at one year follow-up. The authors conclude that proximal fibular osteotomy provides only short-term relief in patients of medial compartment knee osteo-arthritis.

Keywords: Femoro-tibial angle (FTA); OA knees; Proximal fibular osteotomy; VAS; WOMAC.