Proximal Fibular Osteotomy for Medial Compartment Knee Osteoarthritis: Is It Worth?
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ORIGINAL ARTICLE
Proximal Fibular Osteotomy for Medial Compartment Knee Osteoarthritis: Is It Worth? Najmul Huda1 · Mir Shahid ul Islam1 · Hemant Kumar1 · Ajay Pant1 · Sandeep Bishnoi1 Received: 15 April 2020 / Accepted: 29 May 2020 © Indian Orthopaedics Association 2020
Abstract Background Osteoarthritis of knee is one of the important causes of knee pain in elderly patients and is a debilitating disease. It often leads to varus deformity of knee. Many treatment options are available for this progressive knee joint disorder. Proximal fibular osteotomy (PFO) is a novel yet simple procedure used to alleviate the symptoms of medial compartment knee osteoarthritis. The present study was undertaken to evaluate whether this procedure improves the symptoms, functions and limb alignment in patients with medial compartment knee osteoarthritis. Methods Following approval by the Institutional Review Board, this prospective study included 42 cases (56 knees) with Kellgren–Lawrence grade II and III medial compartment knee osteoarthritis and underwent proximal fibular osteotomy. Clinical assessment was done by visual analogue scale (VAS) score and The Western Ontario and McMaster universities osteoarthritis Index (WOMAC) score pre-operatively and at 3, 6 and 12 months follow-up for pain and functional improvement. Radiological assessment was done by measuring femoro-tibial angles (FTA) pre-operatively and at 1 year follow-up. Results The mean age was 58.30 years. There were 30 females and 12 males. The preoperative mean WOMAC score was 87.3, at 3 months follow-up it was 29.4 this was significantly better (p 15°, BMI > 25 were excluded. All the participants, included in the study were subjected to detailed history taking, thorough clinical examination and appropriate imaging work-up which included a full-leg standing ortho scanogram of the lower extremities. Calculation of WOMAC score, VAS score and
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Indian Journal of Orthopaedics
FTA was done. All the participants were assessed for anaesthetic fitness.
Operative Procedure In supine position under spinal/epidural anaesthesia with inflated tourniquet, the limb was prepared and draped. Head of the fibula was identified with image intensifier. A 6–8 cm longitudinal incision was made below the fibular head. We identified the intermuscular plane between soleus and peroneus. The muscles were split to reach the fibula. Site of osteotomy was identified 2.5 inches below the head of the fibula and multiple drill holes were made at the proximal and the distal level of the osteotomy. We avoided using the saw blades to prevent inadvertent injury to the common peroneal nerve. About 1.5 cm of the fibula was resected with the help of an osteotome. Bone wax was applied to the resected ends of the fibula. Closure was done. In bilateral involvement, both the limbs were operated at the same time. Post operatively all the patients were given injectable analgesics and antibiotics along with other supportive medicines. Patients were discharged on the second day after surgery with the adv
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