A clinico-radiological evaluation of functional outcome of proximal fibular osteotomy for medial compartment knee osteoarthritis: a new emerging technique


  • Arun Vashisht Department of Orthopaedics, Subharti Medical College, Meerut, UP, India
  • Gaurav Menwal Department of Orthopaedics, Subharti Medical College, Meerut, UP, India
  • Rachit Bhatnagar Department of Orthopaedics, Subharti Medical College, Meerut, UP, India






Background: The medial compartmental osteoarthritis (OA) knee is initially treated conservatively followed by lateral close/open medial wedge high tibial osteotomy (HTO), or by unicompartmental or total knee replacement (UKR/TKR). Though HTO and UKR/TKR yield good results but are technically more demanding and are fraught with risk of complications, moreover replacement may not be the treatment of choice for younger patients. The objective of this study was to evaluate the efficacy of proximal fibular osteotomy (PFO), a minimally invasive procedure minus risks associated with HTO/TKR.

Methods: Thirty-eight patients, 15 males and 23 females with a mean age of 54.46 years (range, 35 to 80 years) underwent PFO for OA knee and were followed for a mean period of 8.63 months (range 6 to 12 months).

Results: After PFO all patients experienced immediate significant relief in medial knee pain with improved walking distance. Postoperatively, all patients showed radiological improvement in femorotibial angle (FTA), medial/lateral joint space ratio.

Conclusions: PFO is safe, minimally invasive technique with minimal complications. It gives immediate relief of medial knee pain with improved function of joint.

Author Biography

Arun Vashisht, Department of Orthopaedics, Subharti Medical College, Meerut, UP, India

Professor in Department of Orthopedics


Focht BC. Move to improve: how knee osteoarthritis patients can use exercise to enhance quality of life. ACSM’s Health Fit J. 2012;16:24-8.

Felson DT, Naimark A. Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly: The Framingham Osteoarthritis Study. Arthritis Rheum. 1987;30(8):914-8.

Vincent KR, Conrad BP, Fregly BJ, Vincent HK. The pathophysiology of osteoarthritis: a mechanical perspective on the knee joint. PM R. 2012;4(5): 3-9.

Wise BL, Niu J, Yang M. Patterns of compartment involvement in tibiofemoral osteoarthritis in men and women and in Caucasians and African Americans. Arthritis Care Res (Hoboken). 2012;64(6):847-52.

Shiozaki H, Koga Y, Omori G, Yamamoto G, Takahashi HE. Epidemiology of osteoarthritis of the knee in rural Japanese population. Knee. 1999;6(3):183-8.

Ahlback S. Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol. 1968;277(l):7-72.

Annette WD, Robertsson O, Lidgren L. Surgery for knee osteoarthritis in younger patients. Acta Orthopaedica. 2010;81(2):161-4.

Annette WD, Robertsson O, Lidgren L. Surgery for knee osteoarthritis in younger patients. Acta Orthopaedica. 2010;81(2):161-4.

Kakihana W, Akai M, Nakazawa K, Takashima T, Naito K, Torii S. Effects of laterally wedged insoles on knee and subtalar joint moments. Arch Phys Med Rehabil. 2005;86:1465-71.

Butler RJ, Marchesi S, Royer T, Davis IS. The effect of a subject-specific amount of lateral wedge on knee mechanics in patients with medial knee osteoarthritis. J Orthop Res. 2007;25:1121-7.

Kuroyanagi Y, Nagura T, Matsumoto H. The lateral wedged insole with subtalar strapping significantly reduces dynamic knee load in the medial compartment gait analysis on patients with medial knee osteoarthritis. Osteoarthritis Cartilage. 2007;15:932-6.

Erhart JC, Mundermann A, Elspas B, Giori NJ, Andriacchi TP. A variable-stiffness shoe lowers the knee adduction moment in subjects with symptoms of medial compartment knee osteoarthritis. J Biomech. 2008;41:2720-5.

Lindenfeld TN, Hewett TE, Andriacchi TP. Joint loading with valgus bracing in patients with varus gonarthrosis. Clin Orthop Relat Res. 1997;344:290-7.

Draganich L, Reider B, Remington T, Piotrowski G, Mallik K, Nasson S. The effectiveness of self-adjustable custom and off-the-shelf bracing in the treatment of varus gonarthrosis. J Bone J Surg Am. 2006;88:2645-52.

Huskisson E. Measurement of pain. Lancet. 1974;304:1127-31.

Wang F, Chen BC, Gao S. Influence of knee lateral thrust gait to femorotibial angle and lateral joint space in the knee varus patients. Chinese J Orthop. 2005;25(9):517-9.

Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248(248):13-4.

Wu LD, Hahne HJ, Hassenpflug T. A long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis. Chin J Traumatol. 2004;7:348-53.

Sprenger TR, Doerzbacher JF. Tibial osteotomy for the treatment of varus gonarthrosis: survival and failure analysis to twenty-two years. J Bone Joint Surg Am. 2003;85:469-74.

Schnurr C, Jarrous M, Gudden I, Eysel P, Konig DP. Pre-operative arthritis severity as a predictor for total knee arthroplasty patients’ satisfaction. Int Orthop. 2013;37(7):1257-61.

Zhang YZ. Innovations in Orthopaedics and Traumatology in China. Chin Med J. 2015;128:2841-2.

Wang. 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.






Original Research Articles