Simultaneous Application of Proximal Fibular Osteotomy and Unicondylar Knee Arthroplasty.

Nihat Demirhan Demirkıran

doi:10.7759/cureus.4763

Abstract

Proximal fibular osteotomy (PFO) is a simple, easy and cheap procedure consisting of removing a 10 mm piece of fibula 6 to 9 cm below the fibular head. Proximal osteotomy of the fibula weakens the lateral fibular support and leads to a correction of the varus deformity and provides a widening on the medial joint space. Unicondylar knee arthroplasty (UKA) is intended to treat isolated medial compartment arthritis. However, knees with a varus deformity and tight medial joint space might cause both technical difficulties and poorer outcomes. A 68-year-old female with complaints of pain on the medial side of both knees for more than two years underwent bilateral UKA. While inserting the trial meniscal bearing was not easy due to the varus tight knee, at that stage, instead of performing a deeper cut, a PFO procedure was considered which provided widening of the medial joint space. We report, to our knowledge, the first simultaneous application of these two procedures. Despite being a single case with very short term results, our results suggest that the combination of PFO and UKA may reduce the loads over the implants on the medial compartment based on the widening of the joint space and varus deformity correction.

Highlights

Osteoarthritis (OA) is a chronic, progressive degenerative disease of synovial joints that causes progressive loss of articular cartilage causing pain and joint deformity
Various factors have been accused in etiology including articular trauma, muscle weakness, obesity or metabolic syndrome, increased age, genetics, and race
We report the simultaneous application of Proximal fibular osteotomy (PFO) and Unicondylar knee arthroplasty (UKA)

Summary

Introduction

Osteoarthritis (OA) is a chronic, progressive degenerative disease of synovial joints that causes progressive loss of articular cartilage causing pain and joint deformity. High tibial osteotomy (HTO) and unicondylar knee arthroplasty (UKA) are common surgical procedures for the treatment of knee OA with satisfying results. Proximal fibular osteotomy (PFO) is a simple, easy and cheap procedure consisting of removing a 10 mm piece of fibula 6 to 9 cm below the fibular head It was described incidentally in the early 2000s, based on follow-up observations of prisoners with medial arthritis of the knee who had relief in symptoms, after proximal fibular fractures frequently encountered in riots [8]. She had tenderness over the medial side of both knees with decreased range of motion. FTA: Femorotibial angle, VAS: Visual analog scale, AKSS: American Knee Society Score (knee score + functional score), Preop: Preoperatively, Postop: Postoperatively

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