Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2020; 11(11): 499-506
Published online Nov 18, 2020. doi: 10.5312/wjo.v11.i11.499
Proximal fibular osteotomy: Systematic review on its outcomes
Munis Ashraf, Prabhudev Prasad Purudappa, Vishaal Sakthivelnathan, Senthilnathan Sambandam, Varatharaj Mounsamy
Munis Ashraf, Department of Orthopedic Surgery, Yenepoya Medical College Hospital, Mangalore 575108, India
Prabhudev Prasad Purudappa, Department of Orthopedic Surgery, Boston VA Medical Center, Boston, MA 02130, United States
Vishaal Sakthivelnathan, School of Medicine, University of Texas Medical Branch, Texas, TX 77030, United States
Senthilnathan Sambandam, Varatharaj Mounsamy, Department of Orthopedic Surgery, Dallas VA Medical center, Dallas, TX 75216, United States
Author contributions: Ashraf M contributed to the study by study design, review of literature, manuscript preparation and submission; Sakthivelnathan V performed the review of literature and statistical analysis; Purudappa PP, Sambandam S and Mounsamy V contributed equally in formulation of study design, editing of manuscript and final review of manuscript.
Conflict-of-interest statement: The authors disclose that there is no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Munis Ashraf, DNB, Orthopedic Surgeon, Department of Orthopedic Surgery, Yenepoya Medical College Hospital, Derlakatte, Mangalore 575108, India. keyi.orth@gmail.com
Received: April 21, 2020
Peer-review started: April 21, 2020
First decision: June 15, 2020
Revised: August 25, 2020
Accepted: September 22, 2020
Article in press: September 22, 2020
Published online: November 18, 2020
Processing time: 207 Days and 2.1 Hours
Abstract
BACKGROUND

The morbidity and burden of knee osteoarthritis affecting millions of lives worldwide has created a constant pursuit in finding the ideal treatment for knee osteoarthritis. There has been a paradigm shift in the surgical treatment of osteoarthritis ever since the initial description of Volkmann’s tibial osteotomy. This review focuses on one such recent procedure, the proximal fibular osteotomy (PFO) for medial compartment knee osteoarthritis. This review encompasses the history, evidence, risk factors, outcomes and technical considerations of PFO.

AIM

To understand the evidence and its techniques, and whether this could be an alternative solution to the problem of knee osteoarthritis in the developing world.

METHODS

The phrases “proximal fibular osteotomy” and “knee osteoarthritis” were searched (date of search December 20, 2019) on PubMed to identify articles evaluating the biomechanical and clinical outcomes of PFO in patients with knee osteoarthritis. A total of 258 were retrieved. After reviewing the summary of the texts, 22 articles written in English were marked for abstract review. Articles that were case studies or cadaver experiments were excluded. The abstracts of the remaining articles were read, and only those that focused on the history, outcomes of case studies and technical considerations of PFO were included in the review. A total of 12 articles were included in this review.

RESULTS

At least six studies reported improvement in the visual analogue scale(VAS) from the average preoperative VAS score [6.32, 95% confidence interval (CI) = (4.05, 8.59)] to average postoperative VAS score [1.23, 95%CI: (-1.20, 3.71)], which was statistically significant. Similarly, the American Knee Society Score (KSS) functional score improved from an average preoperative KSS functional score [43.11, 95%CI: (37.83, 48.38)] to postoperative KSS functional score [66.145, 95%CI: (61.94, 70.35)], which was statistically significant. The femorotibial angle improved by around 7º, and the hip knee ankle angle improved by around 6º.

CONCLUSION

With the existing data, it seems that PFO is a viable option for treating medial joint osteoarthritis in selected patients. Long term outcome studies and progression of disease pathology are some of the important parameters that need to be addressed by use of multicenter randomized controlled trials.

Keywords: Proximal fibular osteotomy; High tibial osteotomy; Knee osteoarthritis; Functional outcome; Orthopedic

Core Tip: The treatment of knee osteoarthritis with total knee arthroplasty is still a luxury and far-fetched for most patients from developing countries. The burden caused by the morbidity of knee osteoarthritis is more in Asian countries than in western countries, hence a treatment modality that could address this specific population subgroup within their financial hold is needed.