Knee osteoarthritis (OA) is a prevalent chronic, progressive, degenerative condition in older individuals, characterized by joint pain, stiffness, and deformity. The rate of articular degeneration in weight-bearing areas exceeds that in non-weight-bearing regions of the joint, which subsequently calcify to form osteophytes. Patients who do not find relief from oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids may benefit from intra-articular injections of platelet-rich plasma (PRP) and surgical interventions such as proximal fibular osteotomy (PFO), high tibial osteotomy (HTO), and total knee replacement (TKR).
Vedant Bajaj et al conducted a study to evaluate the efficacy of PFO in treating medial compartment OA of the knee. This has been published in ‘Cureus’ journal.
A total of 21 patients with medial compartment OA who attended the orthopedics outpatient department (OPD) were included. Patients diagnosed with medial compartment OA underwent PFO. The outcomes of the treatment were assessed using the visual analog scale (VAS) score and the Modified Oxford Knee Score.
Key findings of the study were:
• The study included 15 females and 6 males.
• There was an improvement in medial knee pain in nearly all patients following PFO.
• Improvements were noted in the medial joint space, VAS score, and Modified Oxford Knee Score.
The author concluded – “PFO is a dependable procedure for early-stage OA of the knee with genu varum deformity, provided the deformity is less than 15°. The effectiveness of PFO largely stems from the release of tight soft-tissue structures connected to the fibular head and the correction of uneven loading on the tibial weight-bearing articular surface. PFO is a straightforward and quick operation that can be completed within 30-40 minutes with minimal blood loss, approximately 30-50 ml. The procedure allows for early ambulation with full weight-bearing in the postoperative period, which is an additional benefit. Early functional and radiological outcomes have shown promise in terms of pain relief, improved functional scores, correction of the tibiofemoral angle, and a slight increase in medial joint space. Our hypothesis that PFO alleviates pain and improves the functional status of patients by shifting the mechanical axis from the medial to the lateral compartment and reducing pressure in the medial compartment appears valid, although the precise mechanism requires further study. Postoperative complications such as paresthesia over the dorsum of the foot and EHL weakness can be prevented by careful retractor placement and avoiding excessive stretching of soft tissues, which minimizes injury to the branches of the CPN. Therefore, in appropriately selected cases, PFO may serve as an alternative to HTO or unicompartmental knee arthroplasty (UKA) for early OA knees with genu varum deformity to prevent disease progression. If disease progression eventually necessitates TKA, it can be safely performed without any complications due to prior PFO. The limitations of our study were a small sample size and our inability to obtain a scanogram at our center.”
Further reading:
Proximal Fibular Osteotomy in the Management of Medial Compartment Osteoarthritis of the Knee: A Prospective Study
Vedant Bajaj et al
Cureus 17(8): e89751. DOI 10.7759/cureus.89751
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