A PROSPECTIVE STUDY ON THE FUNCTIONAL OUTCOME OF PROXIMAL FIBULAR OSTEOTOMY IN GRADE 2 AND 3 MEDIAL COMPARTMENT ARTHRITIS OF THE KNEE.

Introduction: Osteoarthritis of the knee is a common musculoskeletal diseases affecting a major population in India. It can impact the individual's functions and activities of daily living. Total knee arthroplasty may raise controversy when treating the younger, athletic patient with arthritis. Arthroscopic debridement, high tibial osteotomy, unicondylar knee arthroplasty, and total knee arthroplasty allow younger patients to maintain an active, healthy lifestyle but can take a longer time to rehabilitate. PFO could be used as an alternative procedure. The Proximal Fibular Osteotomy, which provides immediate short term relief in cases with medial compartment osteoarthritis. Resecting a segment of fibula, loosens the lateral side allowing the upper tibia to settle into a more favorable lateral alignment, shifting the mechanical axis towards neutral or valgus. Aims & objectives: Ÿ To assess the functional, clinical and radiological outcome of proximal fibular osteotomy in grade 2 and 3 OA of knee and followed up for 1 year. Ÿ The clinical and functional outcome is accessed by Knee Society Score and VAS observed pre-op , post-op ,3 months ,6 months and 12 months. Ÿ The improvement in radiology is accessed using change in the medial joint space improvements in CP angle, change in the ratio of medial joint space to lateral joint space observed pre-op and post-op Methodology: The patients selected had grade 2 and 3 Osteoarthritis of knee according to Kellgren Lawrence classification between the age groups 20yrs-80yrs and are admitted to RajaRajeswari Medical College and Hospital, Bangalore. The Sample Size is 30 and is calculated based on previous studies as well as approximate availability of number of cases in the above mentioned duration satisfying inclusion and exclusion criteria. Clinical, functional and radiological outcome were used, Results were calculated using Knee Society Scoring Scale score. This study Conclusion: suggested that Proximal Fibular Osteotomy is an alternative procedure that can be used to treat medial compartment knee Osteoarthritis, if the patients are selected carefully. Patients followed up for one year showed a significant improvement in radiological, clinical and functional outcomes and thereby is an effective method of treatment in younger patients with Grade 2 and Grade 3 Osteoarthritis with an average BMI of 26.2.

Proximal tibiofibular stabilization by anatomical ligamentoplasty and diaphyseal osteotomy of the fibula / 中华创伤杂志(英文版)

Proximal tibiofibular instability is a rare condition for which treatment is poorly codified. A 21-year-old patient, a leisure sportswoman, presented a post-traumatic anterolateral instability of the proximal tibiofibular articulation without cartilage lesion. We propose an original surgical technique based on a review of the literature that combines an anatomical ligamentoplasty of the proximal tibiofibular joint and a proximal fibular diaphyseal osteotomy to reduce the distal tibiofibular mechanical stresses. This original technique allows a favorable evolution with recovery of professional and sports activities at 6 months.

Proximal Fibular Osteotomy–How Far Is The Total Knee Replacement?

After removal of the proximal section of the fibula, patients with medial compartment knee OA showed greater improvement in alignment, knee range of motion and pain at an early stage.The goal of this study to assess clinical outcomes of patients with medial compartment osteoarthritis treated by proximal fibular osteotomy. Atotal of 40 patients were included in this study for follow-up of 12 months. At final follow-up, mean lateral joint space were and 6.2±0.5 mm which were significantly lower than preoperatively. Mean KSS at final follow-up was 90.7±29.5, which was significantly larger than the preoperative score (43.0±19.3). Mean VAS score at final follow-up was 1.7±1.57 which was significantly lower than the preoperative data (7.73±0.88). Four patients subsequently underwent total knee arthroplasty at a mean of 10.2 months (range, 8-12 months)

Proximal Fibular Osteotomy: A Novel Technique for Management of Medial Compartment Knee Osteoarthritis

For medial compartment knee OA, which is usually seen in the age group 40-50 years, total knee replacement is not recommended ideally. Hence, for these patients, there is need of a new procedure which would be safe, effective & affordable. Objective: The aim of this study is to evaluate the early benefits of proximal fibular osteotomy (PFO) in medial compartment knee OA. Methods: Total 50 patients (70 knees) with medial compartment OA included in this study from march 2017 to august 2017. All patients were managed by PFO and followed-up prospectively for minimum upto 12 months. Visual analogue scale to assess knee pain, American knee society score (AKSS) to evaluate knee functions and medial/lateral joint space ratio were used for radiological assessment. Statistical analysis done by using SPSS 20.0 software.. Results: All patients observed significant relief in knee pain after PFO. AKSS and medial/lateral joint space ratio improved significantly postoperatively. Most of the patients showed increased walking distance post-operatively. Conclusion: This study concludes that PFO is a safe & effective method for the management of medial compartment knee OA. It relieves knee pain significantly and improves knee joint function

Osteotomía del peroné, nueva técnica quirúrgica en el genu varo doloroso. Proceder y presentación de dos casos / Fibular osteotomy, new surgical technique in the painful genu varum: procedure and two-case presentation

La artrosis de rodilla puede llegar a ser una patología muy invalidante por los síntomas que produce, caracterizados por dolor, inseguridad y pérdida funcional. Es una patología degenerativa cuya prevalencia ha ido en aumento en las últimas décadas. Está muy ligada al aumento de las expectativas de vida de la población, fenómeno que ocurre en países del primer mundo con un alto nivel de salud y que ocurre igualmente en nuestro país dado el desarrollo de nuestro sistema de salud. Existen múltiples técnicas quirúrgicas para corregir la deformidad y aliviar el dolor; van desde osteotomías correctoras hasta las artroplastias, todas encaminadas al alivio del dolor en primer lugar y a corregir las deformidades, pero las últimas conllevan mayor tiempo de rehabilitación y son más costosas. Este trabajo va encaminado a la presentación de dos pacientes operados con la nueva técnica del Dr. Ying Ze Zhang, del Departamento de Cirugía Ortopédica del Tercer Hospital de la Universidad Médica de Hebei en Shijiazhuang, China, con la cual, a través de una osteotomía, se descomprime el compartimento interno y se quita tensión ósea en el externo por la resección peronea. Sus objetivos son actuar sobre el dolor, mejorar la función y la marcha como beneficios de este proceder de mínima acción sobre las partes articulares y lograr la rápida incorporación del paciente a su vida social; esto es tema para la obtención del doctorado por parte del autor principal del presente trabajo (AU).

Knee osteoarthritis could be a very disabling disease due to the symptoms it produces, characterized by pain, insecurity and functional loss. It is a degenerative disease which prevalence has increased in the last decades tightly related to the increment of the population's life expectancy, phenomenon occurring in the developed countries with a high life level and also occurring in our country because of the development of our health system. There are several surgical techniques to correct deformation and to relieve pain. They go through correcting osteotomies to arthroplasties, all of them aimed, firstly to pain relieving and also to correcting deformations. The last ones need more rehabilitation time and are more expensive. This work is devoted to presenting two patients operated with the new technique of Dr. Yin-Ze Zhang, from the Department of Orthopedic Surgery of the Third Hospital of the Medical University of Hebei, in Shijiazhuang, China, with which, through an osteotomy, the internal compartment is decompressed and the bone tension in the external one is finished due to the peroneal excision. Its aims are acting upon the pain, improving function and gait as a benefit of this minimal action procedure on the articular parts and achieving the faster incorporation of the patient to his social life; this is the theme the main author of this article is going to develop for obtaining the doctorate in sciences (AU).

Fibular osteotomy with autogenous iliac bone graft in treatment of postoperative nonunion of tibia / 第二军医大学学报

Objective To assess the clinical efficacy of fibular osteotomy with autogenous iliac bone graft for treatment of nonunion of the tibia. Methods A cohort of 45 patients with postoperative nonunion of tibia between Jul. 2008 and Jun. 2013 were treated by fibular osteotomy combined with autogenous iliac bone graft in Changhai Hospital of Second Military Medical University. According to anatomical classification, there were 29 cases of hypertrophic nonunion, 17 cases of atrophic nonunion and two cases of pseudoarthrosis. For primary fixation, 32 cases had plates internal fixation, 11 had intramedullary nail and two had external fixation. Eight patients with stable plate internal fixation were treated by fibular osteotomy with autogenous iliac bone graft, 35 patients with failed internal fixation and two patients with failed external fixation were treated by removing implant and exchanging compression plate with fibular osteotomy using autogenous iliac bone graft The status of fracture healing and relative complications were assessed by lateral and frontal X-ray. Functional recovery of the ankle was evaluated by Olerud-Molander Ankle Score (OMAS). Results The operation time was 1. 3-2. 5 (1. 7 ± 0. 5) h, the intra-operation blood loss volume was 200-500 (250. 0 ± 59. 6) mL, the fibular osteotomy length was 2-3 (2. 4 ± 0. 5) cm, and the volume of iliac grafting was 3-23 (7. 8 ± 1. 3) cm3. The follow-up time was 12-48 (16. 5 ± 3. 3) months and the fraction healing time was 3-11 (5. 6 ± 2. 4) months. The healing of 26(58%) patients took 3-5 months, 13(29%) patients took 6-8 months and 6(13%) patients took 9-11 months. Twenty-seven patients had no limb shortening, nine patients had limb shortening of 2 cm. The function of lower limb joints was excellent in 23 cases, good in 14 cases, common in 5 cases and bad m 3 cases at last follow-up. Conclusion The fibular osteotomy with autogenous iliac bone graft can create pressure on the broken bone end and increase the broken bone end contact area, promoting fracture healing and reducing complications.