Gait Improvement in Patients with Knee Osteoarthritis after Proximal Fibular Osteotomy

Severe medial osteoarthritis predicts patient dissatisfaction after proximal fibular osteotomy: a mid- to long-term follow-up study

PURPOSE

This study aimed to investigate postoperative patient satisfaction at mid- to long-term follow-up after proximal fibular osteotomy and to identify risk factors for patient dissatisfaction.

METHODS

This was a retrospective cross-sectional study that included 252 knees from 160 osteoarthritis (OA) patients who underwent proximal fibular osteotomy with a follow-up of four to eight years. Patients were categorized into a satisfied group (satisfaction score ≥ 20) or a dissatisfied group (satisfaction score < 20) based on the New Knee Society Score (New KSS). Patient demographics, preoperative pain visual analogue scale (VAS) score, preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Kellgren-Lawrence (K-L) grade, preoperative hip-knee-ankle (HKA) angle, and preoperative medial proximal tibial angle (MPTA) were compared between the two groups. Multiple logistic regression analysis was used to identify risk factors for patient dissatisfaction.

RESULTS

Of the 203 knees, 130 (64.0%) were satisfied with their results. Multiple logistic regression analysis demonstrated that severe medial OA (K-L grade = IV) was an independent risk factor for patient dissatisfaction after proximal fibular osteotomy (OR 8.334, 95% CI 3.815-18.206, P < 0.001).

CONCLUSION

Our study confirmed that proximal fibular osteotomy was a simple and effective treatment for medial OA patients, and majority of our patients obtained a higher satisfaction rate within mid- to long-term follow-up after surgery. Severe medial OA, however, was an independent risk factor for dissatisfaction.

Retracted: Gait Improvement in Patients with Knee Osteoarthritis after Proximal Fibular Osteotomy

[This retracts the article DOI: 10.1155/2022/1869922.].

Proximal fibular osteotomy versus high tibial osteotomy for treating knee osteoarthritis: a systematic review and meta-analysis

BACKGROUND

Knee osteoarthritis (KOA) with varus alignment and medial space stenosis is a common degenerative disorder in the elderly. To reallocate the force bearing from the medial to the lateral compartment, the anti-varus osteotomy, including high tibial osteotomy (HTO) and proximal fibular osteotomy (PFO), corrects the mechanical lines of lower extremities using surgical methods, which alleviates the abrasion of medial cartilage and relieves pain. PFO is based on the "non-uniform settlement" theory. It is to cut small section of the proximal fibula, i.e., below the fibula head, which breaks the fibula and weakens its support for the lateral of the tibial plateau, lastly reduces the gap on the lateral side of the knee joint and offsets the knee varus deformity caused by weight bearing. We conducted this systematic review and meta-analysis to compare the clinical outcomes of PFO versus HTO intervention.

METHODS

Twenty-three studies were acquired from PubMed, Embase, CNKI (China National Knowledge Infrastructure), Wanfang Database and Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed by RevMan5.3. Mean differences (MDs), odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale were used to assess risk of bias.

RESULTS

Twenty-three studies including 14 randomized controlled trials and 9 observational studies were assessed. The methodological quality of the trials ranged from low to high. The pooled results of the mean operation time (MD =  - 38.75, 95% CI =  - 45.66 to - 31.85, P < 0.00001), intraoperative bleeding (std. MD =  - 4.12, 95% CI =  - 5 to - 3.24, P < 0.00001), length of hospital stay (MD =  - 3.77, 95% CI =  - 4.98 to - 2.56, P < 0.00001) and postoperative complications (OR = 0.66, 95% CI = 0.37-1.18, P = 0.16) showed that the differences were statistically significant between the two interventions. The postoperative differences of visual analogue score (VAS) (MD = 0.15 95% CI =  - 0.39 to 0.69, P = 0.58), hospital for Special Surgery knee score (HSS) (MD =  - 2.68, 95% CI =  - 6.30 to 0.94, P = 0.15), American knee society (AKS) score (MD = 0.04, 95% CI =  - 0.69 to 0.77, P = 0.91), western Ontario and McMaster university of orthopedic index (WOMAC) (MD = 8.09, 95% CI = 2.06-14.13, P = 0.009) and femur-tibia angle (FTA) (MD =  - 0.03, 95% CI =  - 5.39 to 5.33, P = 0.99) were not statistically significant. Sensitivity analysis proved the stability of the pooled results and the publication bias was not apparent.

CONCLUSIONS

PFO and HTO have the same short-term efficacy in the treatment of KOA, but PFO can reduce the operation time, intraoperative bleeding, hospital stay and postoperative complications, which has certain advantages. Clinically, for patients with many complications and poor surgical tolerance, PFO can be preferred.