Mechanism and influencing factors of proximal fibular osteotomy for treatment of medial compartment knee osteoarthritis: A prospective study

Objectives This study was performed to explore the mechanism of proximal fibular osteotomy (PFO) for treatment of medial compartment knee osteoarthritis (OA) and evaluate the relevant factors influencing the treatment outcome. Methods Fifty-two patients with medial compartment knee OA with varus deformities were prospectively selected. Radiographs were obtained preoperatively and postoperatively. Knee function and OA severity were evaluated using the Hospital for Special Surgery (HSS) knee score and the Kellgren-Lawrence (KL) score. Multivariable linear regression models were used to examine associations between increases in the HSS score and selected factors influencing knee OA. Results Sixty-seven knee joints of 45 patients undergoing PFO were included. The HSS scores were significantly better at the final follow-up than preoperatively. Regression analysis identified five factors influencing changes in the HSS score: the change in the vertical distance between the fibular head and tibial plateau, the KL score for tibiofibular joint arthritis, the body mass index, the inclination of the tibiofibular joint, and the preoperative HSS score. Conclusions PFO is a simple and effective procedure for medial compartment knee OA. Greater distal displacement of the fibular head suggests greater range of motion of the tibiofibular joint and more evident improvement of postoperative OA symptoms.