Proximal Fibular Osteotomy in Treatment of Medial Unicompartmental Knee Osteoarthritis in Elderly Patients

Background: Osteoarthritis (OA) involves mainly the medial tibiofemoral joint of the knee as the stresses of weight bearing mainly involve the medial condyle of the tibia: thus, this is the primary site for knee OA. The work aimed to evaluating the results of proximal fibular osteotomy alone or conducted with arthroscopic lavage and debridement for treatment of medial unicompartmental knee osteoarthritis in elderly patients.

Methods: This study was carried out on 37 cases with knee pain with medial compartment knee osteoarthritis with varying degrees of genu varum. Patients grouped randomly into two matched groups regarding age, sex, BMI and degree of osteoarthritis. Group 1 (n=18) had undergone proximal fibular osteotomy alone and group 2 (n=19) had undergone proximal fibular osteotomy conducted with arthroscopic debridement and lavage.

Results: The mean VAS and mean knee sub scores improved in group (A) and (B) postoperatively than preoperatively (p-value <0.0001). Comparing the two groups according to mean (VAS) and mean knee sub scores, it was found that p-value was <0.001 which was statistically significant. The mean ratio of knee joint space it was found that p-value was <0.001 which was statistically significant.

Conclusions: PFO is a convenient surgical option in most developing countries like Egypt with low medical and financial resources. PFO may delay or even negate the need for total knee arthroplasty. PFO may be A viable alternative procedure for medial compartment knee osteoarthritis, especially for patients who cannot undergo TKA because of certain medical co morbidities. Care must be taken to avoid common peroneal nerve injuries. Knee arthroscopic lavage helps in decreasing knee pain and knee improving joint function by washing of crystals and debris that may induce inflammation and pain.