Proximal fibular osteotomy in the treatment of medial osteoarthritis of the knee \u2013 A narrative review of literature

Saseendar Shanmugasundaram,Samundeeswari Saseendar,Srinivas B S Kambhampati

doi:10.1186/s43019-019-0016-0

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.

Highlights

Osteoarthritis (OA) of the knee is the commonest form of OA
Varus deformity is known to be common in primary OA of the knee with a reported incidence as high as 63% reported by Barrett et al [7] in a population with an average age of 72 years in 2197 weight-bearing radiographs of the knee, and more than 97% in patients with radiographic OA in the rural Japanese population [6]
They concluded that patients with a near-normal hip-knee angle (HKA) angle showed better outcomes in joint function, which might be because Proximal fibular osteotomy (PFO) could only partially correct the varus deformity of the tibial plateau

Summary

Introduction

Osteoarthritis (OA) of the knee is the commonest form of OA. It occurs commonly in the medial compartment. The prevalence in a rural Japanese population of symptomatic knees with radiographic OA (grade 2 and above) was 35.6% and 26.5% among women and men, respectively, with almost all of the knees with radiographic OA exhibiting a varus deformity [6]. A search in the Cochrane Library for “proximal fibular osteotomy” gave seven results, only one of which was relevant to PFO. After accounting for duplication of articles and overlap of search results, there were 10 articles that assessed the clinical or biomechanical effects of PFO in medial OA of the knee. This included articles that used the term “upper partial fibulectomy” instead of “proximal fibular osteotomy.”. A systematic review was not done as there were few long-term outcome studies of PFO

Discussion

What is the maximum varus angle up to which the procedure can be successful?

Findings

Conclusions