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Proximal Fibular Osteotomy: Pain Relief of Medial Compartment Knee Osteoarthritis.
Keywords:
Knee Osteoarthritis, Medial compartment knee arthritis, Osteoarthritis, Proximal fibular osteotomy (PFO).Abstract
Objective: This study was carried out to compare the mean pain score in patients of medial compartmental osteoarthritis of knee before and after proximal fibular osteotomy (PFO).
Methodology: This single group quasi experimental study of thirty patients was carried out in the Orthopaedic department. The patients of primary knee osteoarthritis involving only medial compartment for 3 months to 2 years with Kellgren and Lawrence grade 2-3 were included in the study. Visual analog scale was used for pain assessment before and after PFO on the day before the surgery and again after two months of surgery. Paired sample t-test was used to compare them.
Results: The patients mean age was 49.63±6.68 years (range 38 – 59 years). There were 19 (63.33%) female and 11 (36.67%) male patients. Mean pre-PFO pain score was 7.30±1.15 (range 5-10). Mean post-PFO pain score was 2.87±0.82 (range 1-4). There were 14 (46.67%) patients with right side involvement and 16 (53.33%) were with left side involvement. Diabetes was diagnosed in 07 (23.33%), hypertension was found in 09 (30.00%) patients. Eleven (36.67%) out of 30 patients were smokers. In age group of 38-50 years, mean pre-PFO pain score was 7.14±1.03 and post-PFO pain score was 2.71±0.73 (p<0.001). In patients having age 51-59 years, mean pre-PFO pain score was 7.44±1.26 and post-PFO pain score was 3.00±0.89 (p<0.001). In male patients, mean pre-PFO pain score was 7.36±1.21 and post-PFO pain score was 2.91±0.83 (p<0.001). In female patients, mean pre-PFO pain score was 7.26±1.15 and post-PFO pain score was 2.84±0.83 (p<0.001).
Conclusion: Proximal fibular osteotomy is an effective method for relief of pain with significant reduction in VAS score and thus functional regain with little or no complications in Kellgren and Lawrence grade 2-3 primary knee osteoarthritis.
References
Wallace IJ, Worthington S, Felson DT, Jurmain RD, Wren KT, Maijanen H, et al. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proceed Nat Acad Sci. 2017;114(35):9332-6.
Bolduc JA, Collins JA, Loeser RF. Reactive oxygen species, aging and articular cartilage homeostasis. Free Radic Biol Med. 2019;132(1):73-82.
Loeser RF, Collins JA, Diekman BO. Ageing and the pathogenesis of osteoarthritis. Nat Rev Rheumatol. 2016;12(7):412-20.
Palazzo C, Nguyen C, Lefevre-Colau MM, Rannou F, Poiraudeau S. Risk factors and burden of osteoarthritis. Ann Phys Rehab Med. 2016;59(3):134- 8.
Pal CP, Singh P, Chaturvedi S, Pruthi KK, Vij A. Epidemiology of knee osteoarthritis in India and related factors. Indian J Orthop. 2016;50(5):518-22.
Heim C, Hügle T. Pain and osteoarthritis. Rev Med Sui. 2018;14(612):1287- 90.
O’Neill TW, Felson DT. Mechanisms of osteoarthritis (OA) pain. Curr Osteoporos Rep. 2018;16(5):611-6.
Wang X, Wei L, Lv Z, Zhao B, Duan Z, Wu W, 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):282-9.
Zou G, Lan W, Zeng Y, Xie J, Chen S, Qiu Y. Early clinical effect of proximal fibular osteotomy on knee osteoarthritis. Biomed Res. 2018;28(21):9291-4.
Dong T, Chen W, Zhang F, Yin B, Tian Y, Zhang Y Radiographic measures of settlement phenomenon in patients with medial compartment knee osteoarthritis. Clin Rheumatol. 2016; 35(6):1573–1578.
Huang W, Lin Z, Zeng X, Ma L, Chen L, Xia H et al. Kinematic characteristics of an osteotomy of the proximal aspect of the fibula during walking: a case report. J Bone Joint Surg. 2017; 7(3):43
Prakash L. PFO—Proximal Fibular Osteotomy in medial compartment arthritis of the knee with varus deformity. EC Orthopaedics. 2019; 10(5):315–321
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
Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. J Am Med Assoc. 2001; 286(2):188–195
Shanmugasundaram S, Kambhampati SB, Saseendar S. Proximal fibular osteotomy in the treatment of medial osteoarthritis of the knee–A narrative review of literature. Knee Surg Relat Research. 2019 Dec;31(1):1-7.
Qin D, Chen W, Wang J, Lv H, Ma W, Dong T 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
Xie W, Zhang Y, Qin X, Song L, Chen Q. Ground reaction vector readjustment-the secret of success in treatment of medial compartment knee osteoarthritis by novel high fibular osteotomy. J Orthop. 2918; 15(1):143–145
Zhang YZ. Innovations in Orthopedics and Traumatology in China. Chin Med J (Engl). 2015;128(12):2841–2.
Laprade RF, Spiridonov SI, Nystrom LM, Jansson KS. Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy. Arthroscopy. 2012;28(3):354-64.
W-Dahl A, Robertsson O, Lidgren L. Surgery for knee osteoarthritis in younger patients. Acta Orthop. 2010;81(2):161-4.
Wang X, Wei L, Lv Z, Zhao B, Duan Z, Wu W, Zhang B, Wei X. 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):282-9.
Portner O. High tibial valgus osteotomy: closing, opening or combined? Patellar height as a determining factor. Clin Orthop Relat Research. 2014;472(11):3432-40.
Giagounidis EM, Sell S. High tibial osteotomy: factors influencing the duration of satisfactory function. Arch orthop trauma surg. 1999;119(7-8):445-9.
Ahmed M, Bux M, Kumar M, Ahmed N, Hussain G, Ishtiyaque M Sr. Proximal Fibular Osteotomy in the Management of Osteoarthritis of Medial Compartment of Knee Joint. Cureus. 2020;12(6):8481.
Wang X, Wei L, Lv Z. 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):282-9.
Subash Y, Naidu GK. The role of proximal fibular osteotomy in the management of medial compartment osteoarthritis of the knee. Int J Orthopaed. 2018;4(3):369-72.
Rai AK, Saurabh A, Shekhar S, Kunwar A, Verma V. Proximal fibular osteotomy for pain relief and functional improvement in patients of osteoarthritis of knee. Int Surg J. 2019;6(7):2368-72.
