1
|
Liang ZJ, Koh DTS, Soong J, Lee KH, Bin Abd Razak HR. Severity of knee osteoarthritis does not affect clinical outcomes following proximal fibular osteotomy - A systematic review and pooled analysis. J Clin Orthop Trauma 2024; 54:102473. [PMID: 39050652 PMCID: PMC11263641 DOI: 10.1016/j.jcot.2024.102473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 06/05/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Background & aims Knee osteoarthritis (KOA) is a progressive degenerative disease of chronic nature. The mainstay of surgical management for KOA would be total knee arthroplasty. Joint preserving options like High Tibial Osteotomy (HTO) and Proximal Fibular Osteotomy (PFO) have been offered as an inexpensive option by knee preservation surgeons. Current literature on PFO outcomes lack of clarity for specific indications for offering PFO based on degree of severity of KOA. Therefore, this systematic review aims to critically evaluate clinical and radiological outcomes of PFO stratified by severity of KOA. Methods PubMed, Scopus, CINAHL and Google Scholar databases were searched. Eligible studies included those published up till August 2023, with 271 studies obtained. After duplicate removal, title-abstract screening, and a full text screen based on inclusion and exclusion criteria, 11 papers were included. 46 papers were further identified from snowballing of 7 existing systematic reviews, with 2 additional papers subsequently included. Results 13 included articles analysed 788 knees. Our study found that indications based on KL grading of KOA do not seem to differ in terms of post-operative clinical outcomes (VAS score) and radiological measures also found that hip knee alignment was improved regardless of KL grading of KOA. Additionally, the most common post-operative complication reported was deep peroneal nerve palsy. Conclusion PFO is a viable knee joint preserving surgery for medial compartment KOA, however given the high risk for complications reported in the literature, surgeons should pay close attention to the neuroanatomical landmarks and techniques to avoid neurovascular injury.
Collapse
Affiliation(s)
- Zhen Jonathan Liang
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road Level 11, Singapore, 119228, Singapore
- Singapore Knee Preservation Society, Singapore
| | - Don Thong Siang Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, 31 Third Hospital Ave, Singapore, 168753, Singapore
- Singapore Knee Preservation Society, Singapore
| | - Junwei Soong
- Department of Orthopaedic Surgery, Singapore General Hospital, 31 Third Hospital Ave, Singapore, 168753, Singapore
- Singapore Knee Preservation Society, Singapore
| | - Kong Hwee Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, 31 Third Hospital Ave, Singapore, 168753, Singapore
- Singapore Knee Preservation Society, Singapore
| | - Hamid Rahmatullah Bin Abd Razak
- Total Orthopaedic Care & Surgery, Novena Medical Centre, 10 Sinaran Drive, 09-24, 307506, Singapore
- SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, Academia Level 4, 20 College Road, Singapore, 169865, Singapore
- Singapore Knee Preservation Society, Singapore
| |
Collapse
|
2
|
Gavrilovski A, Dimovska AG, Spasov M, Kostov H, Igor IM, Jonoski K, Trpeski S. Alternative Treatment of Gonarthrosis: Proximal Fibular Osteotomy. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2024; 45:13-18. [PMID: 38575383 DOI: 10.2478/prilozi-2024-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Gonarthrosis is arthrosis of the knee joint, a chronic non-inflammatory disease manifested by progressive destruction of the intra-articular cartilage, accompanied by abnormal formation of the bones form the joint, changes in the synovial membrane and synovial fluid. Gonarthrosis is the most common type of arthrosis. Gonarthrosis can be treated conservatively and operatively. Among well-established surgical options for the treatment of medial gonarthrosis are high tibial osteotomy (HTO), unicompart-mental knee arthroplasty (UKA), and total knee arthroplasty (TKA). Proximal fibular osteotomy (PFO) or superior partial fibulectomy is a relatively recent procedure proposed to reduce knee pain in patients with medial compartment. AIM Our study aims to demonstrate an alternative treatment for gonarthrosis with proximal fibular osteotomy and reduced knee pain in patients with medial compartment osteoarthritis of the knee. MATERIALS AND METHODS At the Department of Orthopedics and Traumatology at J.Z.U "Borka Taleski" Prilep in the period from 2018 to 2021, 14 cases were treated, of which 11 were female and 3 were male. All patients were aged between 62 and 82 years with a mean age of 71.3 years. Patients had a severe degree of gonarthrosis (III/IV) according to Kellgren-Lawrence classification. Arthroscopy was performed in 2 patients. The fibula osteotomy was 7 cm away from the fibular head, with 1 cm resected bone fragment from the fibula. RESULTS The average duration of the surgery was 30 minutes. Patients were followed up on the 7th day, first month, 3 months and 6 months after surgery. The final evaluation of function was done after 6 months by examining the active and passive movements of the knee joint. In all 14 patients we have excellent results with pain reduction, improvement of movement and quality of life. CONCLUSION Proximal fibular osteotomy is an option for medial compartment osteoarthritis of the knee. Current literature is limited to small case series which report good outcomes in pain reduction, including the correction of varus deformity in medial gonarthrosis. Further studies are needed to determine the place of the PFO in the medial gonarthrosis management algorithm before it can be recommended for routine clinical use.
Collapse
Affiliation(s)
| | | | - Marko Spasov
- University Clinic of Traumatology (TOARILUC), Skopje, RN Macedonia
| | - Hristijan Kostov
- University Clinic of Traumatology (TOARILUC), Skopje, RN Macedonia
| | | | - Kire Jonoski
- General Hospital Borka Taleski, Prilep, RN Macedonia
| | - Simon Trpeski
- University Clinic of Traumatology (TOARILUC), Skopje, RN Macedonia
| |
Collapse
|
3
|
Nafees K, Baig AAM, Ali SS, Ishaque F. Dynamic soft tissue mobilization versus proprioceptive neuromuscular facilitation in reducing hamstring muscle tightness in patients with knee osteoarthritis: a randomized control trial. BMC Musculoskelet Disord 2023; 24:447. [PMID: 37268961 DOI: 10.1186/s12891-023-06571-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 05/25/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) considered as one of the most common degenerative diseases of synovial joint. KOA is mostly managed by physical therapy, focused on pain management, the range of motion and muscle strengthening but muscle flexibility is usually neglected. A study was conducted to evaluate the effectiveness of dynamic soft tissue mobilization (DSTM) in comparison with the proprioceptive neuromuscular facilitation (PNF) stretching in the management of hamstring tightness, reduction of pain intensity and improvement of physical functionality in KOA. METHODS Forty eight patients with KOA were randomly allocated to group A receiving DTSM and group B receiving PNF stretching. The cryotherapy and isometric strengthening exercises were also given to both groups. Total treatment duration consisted of 4 weeks, 3 sessions per week and total 12 sessions per patient. Each treatment session comprised of 30 min. At baseline and post treatment, Active knee extension test(AKET), Visual analogue scale (VAS), and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to assess hamstring flexibility, pain intensity level and physical functional capability respectively. The continuous variables were shown as mean and standard deviations. For the comparison of outcome within and between groups, paired sample and independent t-test was applied. Considerable p value was less than 0.05. RESULTS The between group analysis of VAS, right AKE test, and left AKE test showed non-significant (p > 0.05) mean difference as 0.2 (95% CI= -0.29, 0.70), 1.79 (95% CI= -1.84, 4.59), 1.78 (95% CI= -1.6, 5.19) respectively. KOOS domains of symptom, pain, ADLs, sports and recreational, and quality of life had also non-significant (p > 0.05) mean difference as 1.12 (95% CI= -4.05, 6.3), -5.12 (95% CI= -12.71, 2.46), -2.55 (95% CI= -7.47, 2.38), -2.7 (95% CI= -9.72, 4.3), and - 0.68 (95% CI= -7.69, 6.36) respectively. Significant (p < 0.001) improvement was shown in both groups for all outcome measures after 12 sessions. CONCLUSION DSTM and PNF stretching, both treatments are equally beneficial in KOA for hamstring flexibility, pain reduction and functional mobility in terms of AKET, VAS, and KOOS respectively. TRIAL REGISTRATION ClincalTrials.Gov with ID: NCT04925895, 14/06/2021, retrospectively registered.
Collapse
Affiliation(s)
- Khadija Nafees
- Department of physiotherapy, Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan.
| | - Aftab Ahmed Mirza Baig
- Department of physiotherapy, Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan
| | - Syed Shahzad Ali
- Department of physiotherapy, Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan
| | - Farhan Ishaque
- Department of physiotherapy, Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan
| |
Collapse
|
4
|
Ahmad Muslim MY, Draman MR, Merican AM, Chong DYR. Changes in the Tibial Strain After Proximal Fibular Osteotomy: A Biomechanical Cadaveric Study. Orthopedics 2022; 45:314-319. [PMID: 35576486 DOI: 10.3928/01477447-20220511-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Total knee arthroplasty surgery is an increasingly common procedure for the treatment of uni- and tricompartmental knee osteoarthritis, particularly in advanced stages and in the older population. Its usage is being extended to younger patients, where implant longevity is of concern. In the younger age group, especially with early disease, other options merit consideration. On the other hand, it may not be possible for elderly patients with medical comorbidities to undergo joint replacement surgery. Proximal fibular osteotomy (PFO) has recently been advocated to treat medial knee osteoarthritis. Although there have been clinical reports showing promising outcomes, the biomechanical basis of this procedure is still unclear. We performed a cadaveric study to investigate the effect of PFO on proximal tibial strain. Eight unpaired cadaveric lower limb specimens were loaded in compression at 2 times body weight. Strain gauges were mounted on various sites on the proximal tibia and fibula. After PFO, there was a significant increase in the lateral tibial strain adjacent to the proximal tibiofibular joint (P<.05). There was moderate effect size reduction in the anteromedial tibial strain as well as moderate effect size increase in the posterior tibial strain. The strain reduction seen at the anteromedial tibia can offer a possible explanation for symptomatic relief after PFO. However, the increase in the lateral and posterior tibial strain raises concern about long-term accelerated wear in these regions. [Orthopedics. 2022;45(5):314-319.].
Collapse
|
5
|
Chen YS, Ang MD, Yang CY, Chang CW. Proximal fibular osteotomy relieves pain in spontaneous osteonecrosis of the knee: A retrospective study. Medicine (Baltimore) 2022; 101:e29585. [PMID: 35905203 PMCID: PMC9333514 DOI: 10.1097/md.0000000000029585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Spontaneous osteonecrosis of the knee (SONK) causes knee pain and joint motion limitation. Ischemia or insufficiency fracture may be the cause, but no consensus has been developed. Proximal fibular osteotomy (PFO) has been reported to relieve pain from osteoarthritis through medial compartment decompression. We reviewed the effect of this procedure on medial compartment SONK patients and explored clinical and radiological results. Since January 2018 to January 2020, the data of 12 knees (8 right and 4 left) from 11 SONK patients (9 women and 2 men) who received PFO were analyzed. The average age was 61.5 years. The diagnosis of SONK was established through weight-bearing anterior-posterior radiographs or magnetic resonance imaging (MRI). Visual analog scale (VAS) scores, Oxford knee score (OKS), Femorotibial angle (FTA), medial joint space, and lateral joint space were documented preoperatively and at follow up visits. Outcome assessment for the clinical and radiographic data was reviewed at 12- and 24-month follow-up visits. The mean follow up period was 33 months. All patients were able to walk with or without cane assistance the day after surgery. Both VAS score and OKS (preoperative: 6.6 ± 0.9 and 24.7 ± 3.8, respectively) improved significantly at the 12-month follow-up, and to 24-month follow-up (3.6 ± 1.3 and 35.6 ± 4.5, respectively, P < .05). Medial joint space ratio increased from 0.36 to 0.50 (P < .05). Changes of FTA were insignificant at any point of follow up. Four patients underwent follow-up MRI, and a decrease in the osteonecrotic area was clearly observed in 2 patients. By achieving medial knee decompression, PFO allowed quick weight-bearing recovery, pain relief, and improvement in knee function in SONK patients.
Collapse
Affiliation(s)
- Yu-Sheng Chen
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Min-De Ang
- Department of Internal medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chyun-Yu Yang
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan City, Taiwan
- Department of Orthopedics, College of Medicine, National Cheng Kung University Hospital, Tainan City, Taiwan
- Department of Orthopaedics, Kuo General hospital, Tainan City, Taiwan
| | - Chih-Wei Chang
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan City, Taiwan
- Department of Orthopedics, College of Medicine, National Cheng Kung University Hospital, Tainan City, Taiwan
- Department of Orthopaedics, Kuo General hospital, Tainan City, Taiwan
- *Correspondence: Chih-Wei Chang, Department of Orthopedics, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan (e-mail: )
| |
Collapse
|
6
|
Gait Improvement in Patients with Knee Osteoarthritis after Proximal Fibular Osteotomy. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1869922. [PMID: 35782074 PMCID: PMC9246634 DOI: 10.1155/2022/1869922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
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.
Collapse
|
7
|
Deng XT, Hu HZ, Wang ZZ, Zhu J, Yang S, Wang YC, Ye ZP, Guan HT, Zhang BY, Cheng XD, Zhang YZ. Comparison of Clinical and Radiological Outcomes Between Upper Fibular Curvature and Non-Curvature with Medial Knee Osteoarthritis Following Proximal Fibular Osteotomy: A Retrospective Cohort Study with Minimum 2-Year Follow-up. Orthop Surg 2021; 13:1369-1377. [PMID: 34018339 PMCID: PMC8274210 DOI: 10.1111/os.13011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 12/31/2022] Open
Abstract
Objective To evaluate and compare the clinical and radiographic outcomes of proximal fibular osteotomy (PFO) in treating medial knee osteoarthritis (KOA) patients with upper fibular curvature and non‐curvature. Methods A retrospective cohort study was performed. From January 2016 to January 2017, a total of 51 patients (nine males and 42 females) at a mean age of 63.7 years (range 48–79 years) with medial KOA who underwent PFO procedure at the Third Hospital of Hebei Medical University were included in the study. The patients were divided into the two groups, namely curvature group (28 patients, six males and 22 females, aged 62.6 ± 7.7 years) and non‐curvature group (23 patients, three males and 20 females, aged 64.5 ± 7.6 years). Perioperative parameters and Kellgren‐Lawrence classification were recorded and analyzed in the two groups, respectively. All patients were followed up at 1, 3, 6, and 12 months at the first year of post‐operation, and then every 6 months from the second year of post‐operation. A telephone survey with standard questionnaire survey, including Visual Analog Scale (VAS) score and Hospital for Special Surgery (HSS) scoring system, was used to evaluate postoperative clinical outcomes. Radiological results were assessed using the femorotibial angle (FTA), hip‐knee‐ankle angle (HKA), and settlement value of medial tibial platform (MTP) in the two groups. Results The average follow‐up periods of the curvature group and the non‐curvature group were 34.8 ± 6.1 and 33.9 ± 5.4 months, respectively. There were no significant differences between the two groups of demographic data in terms of number of patients, age, body mass index (BMI), gender, KOA side, and Kellgren‐Lawrence classification (P > 0.05). The VAS scores of the curvature group and non‐curvature group were (3.53 ± 1.62 vs 3.68 ± 1.43 at 1 month, 3.46 ± 0.79 vs 3.57 ± 0.66 at 3 months, and 2.43 ± 0.88 vs 2.83 ± 0.94 at 6 months, both P > 0.05), while significant differences were found from 12 months post‐operation (1.54 ± 0.72 vs 2.03 ± 0.85 at 12 months, and 1.04 ± 0.69 vs 1.74 ± 0.75 at 24 months, both P < 0.05). The HSS scores of the curvature group and non‐curvature group were (79.67 ± 5.14 vs 78.25 ± 6.37 at 1 month, 84.65 ± 3.76 vs 83.18 ± 3.64 at 3 months, and 86.27 ± 3.13 vs 85.49 ± 3.25 at 6 months, both P > 0.05), while significant differences were found from 12 months post‐operation (90.64 ± 4.32 vs 87.71 ± 5.63 at 12 months, and 92.93 ± 2.07 vs 90.06 ± 2.08 at 24 months, both P < 0.05). In addition, the FTA and settlement value of the curvature group were lower than the non‐curvature group (177.18 ± 1.52 vs 178.35 ± 1.86, and 5.29 ± 1.74 vs 6.49 ± 2.09, both P < 0.05) while the HKA were higher than the non‐curvature group (175.32 ± 2.34 vs 173.83 ± 2.64, P < 0.05) at the final follow‐up. Conclusions Medial KOA patients with upper fibular curvature is an optimal surgical indication for PFO surgery, with the advantages of pain relief, better functional recovery, and alignment correction.
Collapse
Affiliation(s)
- Xiang-Tian Deng
- School of Medicine, Nankai University, Tianjin, China.,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hong-Zhi Hu
- Department of Orthopedics, Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zhong-Zheng Wang
- Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jian Zhu
- School of Medicine, Nankai University, Tianjin, China.,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Sifan Yang
- Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yu-Chuan Wang
- Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhi-Peng Ye
- School of Medicine, Nankai University, Tianjin, China.,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hai-Tao Guan
- School of Medicine, Nankai University, Tianjin, China.,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bo-Yu Zhang
- School of Medicine, Nankai University, Tianjin, China.,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiao-Dong Cheng
- Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ying-Ze Zhang
- School of Medicine, Nankai University, Tianjin, China.,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
8
|
Sugianto JA, Hadipranata T, Lazarus G, Amrullah AH. Proximal fibular osteotomy for the management of medial compartment knee osteoarthritis: A systematic review and meta-analysis. Knee 2021; 28:169-185. [PMID: 33387808 DOI: 10.1016/j.knee.2020.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/10/2020] [Accepted: 11/26/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The promising prospects of proximal fibular osteotomy (PFO) as an alternative treatment of knee osteoarthritis (KOA), which has gained popularity in recent years, has yet to be systematically evaluated. Hence, this meta-analysis aims to critically assess the clinical and radiological outcome of PFO in the management of medial compartment KOA. METHODS Literature searches through PubMed, Scopus, CENTRAL, CINAHL, Google Scholar, and ProQuest databases were conducted, searching for eligible studies published from inception up to April 2020. Risk of bias assessments of randomized trials were performed via Cochrane RoB 2, while those of non-randomized studies with ROBINS-I tool. Random-effects model was utilized to estimate effect sizes. RESULTS A total of 907 patients and 1012 knees were included in this meta-analysis. PFO successfully ameliorated patients' knee function (Hedges' g 1.90; 95% confidence interval (CI) 1.62-2.18; I2 = 67%) and pain (visual analog scale: mean difference (MD) -4.13; 95% CI: -5.29 to -2.97), and also resulted in minimal complication rates, with peroneal nerve paresthesia being the most prevalent adverse event (5.93%; 95% CI: 2.15-11.25%), followed by peroneal nerve palsy (2.25%; 95% CI: 0.14-6.14%), fracture (0.56%; 95% CI: 0-1.74%), and recurrent deformity (0.54%; 95% CI: 0-1.74%). Furthermore, PFO was also associated with improved medial/lateral joint space ratio (MD 0.17; 95% CI: 0.15-0.19). CONCLUSION PFO yielded promising prospects in the management of medial compartment KOA, as shown by substantial improvements in clinical and radiological outcomes. However, considering the low quality of evidence, further studies with more diverse populations and higher quality of body evidence are required to confirm these findings.
Collapse
Affiliation(s)
| | | | - Gilbert Lazarus
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | - Ahmad Hannan Amrullah
- Orthopaedic and Traumatology Surgeon, Ngimbang General Hospital, Lamongan, Indonesia
| |
Collapse
|
9
|
Proximal Fibular Osteotomy: Is it Really an Option for Medial Compartmental Osteoarthritis Knee? Our Experience at Tertiary Centre. Indian J Orthop 2020; 55:228-233. [PMID: 34122774 PMCID: PMC8149489 DOI: 10.1007/s43465-020-00289-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/07/2020] [Indexed: 02/04/2023]
Abstract
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 METHODS We 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.
Collapse
|
10
|
Proximal Fibular Osteotomy for Medial Compartment Knee Osteoarthritis: Is It Worth? Indian J Orthop 2020; 54:47-51. [PMID: 32952909 PMCID: PMC7474049 DOI: 10.1007/s43465-020-00160-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/29/2020] [Indexed: 02/04/2023]
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.
Collapse
|
11
|
Shanmugasundaram S, Kambhampati SBS, Saseendar S. Proximal fibular osteotomy in the treatment of medial osteoarthritis of the knee - A narrative review of literature. Knee Surg Relat Res 2019; 31:16. [PMID: 32660631 PMCID: PMC7219610 DOI: 10.1186/s43019-019-0016-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/04/2019] [Indexed: 12/20/2022] Open
Abstract
Proximal fibular osteotomy has been proposed as a simple and inexpensive alternative to high-tibial osteotomy and unicondylar knee arthroplasty and may be useful for low-income populations that cannot afford expensive treatment methods. However, there is no consensus existing regarding the mechanism by which it acts nor the outcome of this procedure. This study was performed to analyze the available evidence on the benefits of proximal fibular osteotomy and to understand the possible mechanisms in play. There are various mechanisms that are proposed to individually or collectively contribute to the outcomes of this procedure, and include the theory of non-uniform settlement, the too-many cortices theory, slippage phenomenon, the concept of competition of muscles, dynamic fibular distalization theory and ground reaction vector readjustment theory. The mechanisms have been discussed and future directions in research have been proposed. The current literature, which mostly consists of case series, suggests the usefulness of the procedure in decreasing varus deformity as well as improving symptoms in medial osteoarthritis. However, large randomised controlled trials with long-term follow-up are required to establish the benefits of this procedure over other established treatment methods.
Collapse
|
12
|
Comparison of Clinical and Biomechanical Outcomes between Partial Fibulectomy and Drug Conservative Treatment for Medial Knee Osteoarthritis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4575424. [PMID: 31781616 PMCID: PMC6875010 DOI: 10.1155/2019/4575424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/05/2019] [Accepted: 09/17/2019] [Indexed: 02/05/2023]
Abstract
Background Upper partial fibulectomy has been preliminarily proved to have the efficacy for pain alleviation and improvement of function in patients with mild to moderate medial compartment knee osteoarthritis (KOA). However, the previous studies lack the control group with other treatments. The aim of this prospective, randomized controlled study is to compare the clinical and biomechanical effects between upper partial fibulectomy and drug conservative treatment on improvement of clinical pain, function, and gait for patients with mild to moderate medial knee osteoarthritis (KOA) and further discuss its biomechanical mechanism. Methods From August 2016 to February 2017, 49 and 48 patients with mild to moderate medial KOA were allocated to fibulectomy and drug groups. We assessed the patients' visual analog scale (VAS) pain score, Hospital for Special Surgery (HSS) knee score, limb alignment, passive flexion/extension range of motion (ROM) of the knee, and 3D gait kinematics and kinetics parameters before and after intervention. Repeated-measures ANOVA with Dunnett's post hoc assessment and multivariate analysis of variance were applied for intragroup and intergroup comparisons, respectively. Results The improvement in the fibulectomy group on the VAS pain score, HSS knee score, walking speed, and walking knee range of motion (ROM) was statistically better than that in the drug group. The decreased overall peak knee adduction moment (KAM) (decreased by 16.1%) and hip-knee-ankle (HKA) angle (decreased by 0.99° from a more varus alignment to a more neutral alignment) of the affected and operated side 1 year after surgery were observed in the fibulectomy group. Conclusion This research demonstrated that as a biomechanical intervention, upper partial fibulectomy can be a better choice in pain relief and function and gait improvement than drug conservative treatment for patients with early-stage knee OA. The long-term clinical outcomes, indication, and rationale for the improvement in clinical symptoms should be investigated further.
Collapse
|