A Study for Evaluation of Results of Proximal Fibular Osteotomy in Cases of Medial Compartment Osteoarthritis Knee Joint

Abstract

Introduction: Medial compartment osteoarthritis (OA) of the knee is a common degenerative joint disorder characterized by pain, reduced function, and progressive deformity. Traditional treatment options range from conservative management, including analgesics and physiotherapy, to high tibial osteotomy and total knee arthroplasty in advanced stages. Proximal fibular osteotomy (PFO) has recently emerged as a minimally invasive surgical option to relieve pain and improve function by redistributing the load from the medial to the lateral compartment of the knee. Methods: This prospective interventional study was conducted over one year, from November 2017 to October 2018, at the Orthopaedics OPD, male and female wards, and elective operation theatre. A total of 62 patients with medial compartment knee osteoarthritis were enrolled. Study variables included patient sex, age, preoperative pain score, femoro-tibial angle, American Knee Society Score (AKSS) range, and functional score, as well as postoperative outcomes and overall functional results. All patients underwent proximal fibular osteotomy, and their clinical, functional, and radiological parameters were systematically recorded and analyzed to evaluate the efficacy of the procedure. Results: In this study of 41 patients (62 knees) undergoing proximal fibular osteotomy, 29% were male and 71% female, aged 40-65 years, mostly 61–65 years (36.6%). Preoperatively, femoro-tibial angles were mainly 130–134° (33.87%) with severe pain (scores 6–9). Postoperatively, 51 knees corrected to 177–180°, pain scores improved to 1-4 in most knees, medial joint space increased from 2.33 ± 0.58 mm to 4.20 ± 0.30 mm, and lateral joint space decreased to 5.80 ± 0.30 mm. AKSS improved, with 11 patients ≥90 and 49 patients 70–89, while functional scores showed 45 patients ≥80. Overall, 77% had good and 19% excellent outcomes, with minimal complications, demonstrating significant pain relief, functional improvement, and joint correction. Conclusion: Proximal fibular osteotomy is a safe, cost-effective, and minimally invasive procedure that provides significant pain relief and functional improvement in patients with medial compartment osteoarthritis of the knee. It can serve as an alternative surgical option for patients who are not candidates for high tibial osteotomy or total knee arthroplasty, especially in early to moderate OA. Long-term studies are warranted to assess durability and delayed complications.