The middle-term results of proximal fibular osteotomy and percutaneous drilling in the treatment of gonarthrosis

Abstract

This study aimed to investigate the radiographic and functional results of proximal fibular osteotomy (PFO) and percutaneous drilling techniques performed on patients with medial gonarthrosis. This study included 420 knees of 230 patients who underwent surgery in the orthopaedics and traumatology clinic between January 2019 and January 2022. The demographic data of the patients, including age and body mass index (BMI), were recorded together with the joint range of movement, joint space ratio and femorotibial angles. The patients were evaluated using the VAS for pain, WOMAC, Lysholm Knee Score for functionality, and the Short-Form 12 for quality of life. The patients treated with PFO and subchondral drilling comprised 46% females and 54% males with a mean age of 57.08 years, a mean BMI of 31.5 kg/m2, and a mean follow-up period of 24.96±6.05 months. Compared to the preoperative period, there was a statistically significant improvement in postoperative pain, functionality, quality of life, joint range of movement, joint space ratio, and femorotibial angle (p<0.001 for all). When the patients were grouped according to BMI, those with a BMI< 31.5 kg/m² demonstrated a greater improvement in VAS scores. Based on the study results, the implementation of PFO as an initial intervention—prior to procedures such as knee prosthesis and high tibial osteotomy (HTO) appeared to yield favorable outcomes for patients with medial gonarthrosis and a moderate degree of varus deformity.

Keywords

• Genu varus
• Medial Gonarthrosis
• Proximal Fibular Osteotomy
• Subchondral Drilling

References

1. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014;22(3):363-388. doi:10.1016/j.joca.2014.01.003
2. Peras M, Caubère A, Choufani C, Passuti N, Versier G, Barbier O. Does AMIC® provide improvements at least two years after surgery for knee osteochondral lesions? A multicentre retrospective study of 101 patients. Orthop Traumatol Surg Res. 2024;110(1):103774. doi:10.1016/j.otsr.2023.103774
3. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010;26(3):355-369. doi:10.1016/j.cger.2010.03.001
4. Brandt KD. Non-surgical treatment of osteoarthritis: a half century of “advances.” Ann Rheum Dis. 2004;63(2):117- 122. doi:10.1136/ard.2002.004606
5. The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases - PubMed. Accessed September 24, 2024. https://pubmed.ncbi.nlm.nih.gov/3192563/
6. Baldini T, Roberts J, Hao J, Hunt K, Dayton M, Hogan C. Medial Compartment Decompression by Proximal Fibular Osteotomy: A Biomechanical Cadaver Study. Orthopedics. 2018;41(4):e496-e501. doi:10.3928/01477447-20180424- 05
7. Englund M, Roemer FW, Hayashi D, Crema MD, Guermazi A. Meniscus pathology, osteoarthritis and the treatment controversy. Nat Rev Rheumatol. 2012;8(7):412-419. doi:10.1038/nrrheum.2012.69
8. Felson DT, Nevitt MC, Yang M, et al. A new approach yields high rates of radiographic progression in knee osteoarthritis. J Rheumatol. 2008;35(10):2047-2054.

9. Aydın A, Baydar M, Ünkar EA, et al. Evaluation of the effect of vascularized fibula graft harvesting on coronal plane alignment and functional outcomes of the lower limb. Sci Rep. 2024;14(1):15820. doi:10.1038/s41598-024-66847-8
10. Wang X, Wei L, Lv Z, et al. Proximal fibular osteotomy: a new surgery for pain relief and improvement of joint function in patients with knee osteoarthritis. J Int Med Res. 2017;45(1):282-289. doi:10.1177/0300060516676630
11. Zhang YZ. Innovations in Orthopedics and Traumatology in China. Chin Med J (Engl). 2015;128(21):2841-2842. doi:10.4103/0366-6999.168015
12. Yang ZY, Chen W, Li CX, et al. Medial Compartment Decompression by Fibular Osteotomy to Treat Medial Compartment Knee Osteoarthritis: A Pilot Study. Orthopedics. 2015;38(12):e1110-1114. doi:10.3928/01477447-20151120- 08
13. Sabir AB, Faizan M, Singh V, Jilani LZ, Ahmed S, Shaan ZH. Proximal Fibular Osteotomy: Is it Really an Option for Medial Compartmental Osteoarthritis Knee? Our Experience at Tertiary Centre. Indian J Orthop. 2021;55(Suppl 1):228-233. doi:10.1007/s43465-020-00289-y
14. Yazdi H, Mallakzadeh M, Mohtajeb M, Farshidfar SS, Baghery A, Givehchian B. The effect of partial fibulectomy on contact pressure of the knee: a cadaveric study. Eur J Orthop Surg Traumatol. 2014;24(7):1285-1289. doi:10.1007/s00590-013-1381-0
15. Yoo MJ, Shin YE. Open Wedge High Tibial Osteotomy and Combined Arthroscopic Surgery in Severe Medial Osteoarthritis and Varus Malalignment: Minimum 5-Year Results. Knee Surg Relat Res. 2016;28(4):270-276. doi:10.5792/ksrr.15.075
16. Qin D, Chen W, Wang J, et al. Mechanism and influencing factors of proximal fibular osteotomy for treatment of medial compartment knee osteoarthritis: A prospective study. J Int Med Res. 2018;46(8):3114-3123. doi:10.1177/0300060518772715
17. Liu B, Chen W, Zhang Q, et al. Proximal fibular osteotomy to treat medial compartment knee osteoarthritis: Preoperational factors for short-term prognosis. PLoS One. 2018;13(5):e0197980. doi:10.1371/journal.pone.0197980
18. Jaheer HSH, Shetty AA, Choi NY, et al. Preliminary results of high fibular osteotomy (HFO) and cartilage regeneration procedure for medial compartment osteoarthritis of knee with varus deformity. Regen Ther. 2019;10:112-117. doi:10.1016/j.reth.2019.02.001
19. Huda N, Islam MSU, Kumar H, Pant A, Bishnoi S. Proximal Fibular Osteotomy for Medial Compartment Knee Osteoarthritis: Is It Worth? Indian J Orthop. 2020;54(Suppl 1):47-51. doi:10.1007/s43465-020-00160-0
20. Tanaka T, Matsushita T, Miyaji N, et al. Deterioration of patellofemoral cartilage status after medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2019;27(4):1347-1354. doi:10.1007/s00167-018-5128-7
21. Kraeutler MJ, Aliberti GM, Scillia AJ, McCarty EC, Mulcahey MK. Microfracture Versus Drilling of Articular Cartilage Defects: A Systematic Review of the Basic Science Evidence. Orthop J Sports Med. 2020;8(8):2325967120945313. doi:10.1177/2325967120945313
22. Wu ZX, Ren WX, Wang ZQ. Proximal fibular osteotomy versus high tibial osteotomy for treating knee osteoarthritis: a systematic review and meta-analysis. J Orthop Surg Res. 2022;17(1):470. doi:10.1186/s13018-022-03299-8
23. Guo J, Zhang L, Qin D, et al. Changes in ankle joint alignment after proximal fibular osteotomy. PLoS One. 2019;14(3):e0214002. doi:10.1371/journal.pone.0214002