Öz
Abstract
Purpose: This study aims to compare the clinical and radiological outcomes of proximal fibular osteotomy (PFO) combined with arthroscopic debridement (AD) versus arthroscopic debridement alone in patients with medial compartment knee osteoarthritis (MCOA).
Materials and Methods: This retrospective study included 85 knees from 74 patients with MCOA who were treated at our hospital between May 2019 and January 2023. Group I comprised 44 knees that underwent AD alone, while Group II included 41 knees that received PFO combined with AD. Preoperative and postoperative clinical and radiological parameters were evaluated within each group. Postoperative outcomes and complication rates were also compared between the groups.
Results: The mean postoperative pain score (VAS) was significantly lower in Group II (3.21 ± 2.04) compared to Group I (6.45 ± 1.62). The mean postoperative Oxford Knee Score was significantly higher in Group II (33.26 ± 7.38) than in Group I (27.14 ± 5.61). Additionally, postoperative radiological parameters, including medial joint space, lateral joint space, and the joint space ratio, were significantly better in Group II compared to Group I.
Conclusion: PFO combined with AD is an effective treatment option for MCOA, providing both clinical and radiological improvements with a low complication rate.
Anahtar Kelimeler
Arthroscopic debridement knee osteoarthritis Oxford Knee Score proximal fibular osteotomy.
Kaynakça
- Bashekah KA, Zagzoug ME, Banaja AW, Alghamdi AA, Mishiming OS, Jan MA et al. Prevalence and characteristics of knee osteoarthritis among the general public in saudi arabia. Cureus. 2023;15:e47666.
- Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. E ClinicalMedicine. 2020;29-30:100587.
- Yang G, Wang J, Liu Y, Lu H, He L, Ma C et al. Burden of knee osteoarthritis in 204 countries and territories, 1990-2019: Results from the global burden of disease study 2019. Arthritis Care Res (Hoboken). 2023;75:2489-500.
- Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59:1207-13.
- Muraki S, Akune T, En-Yo Y, Yoshida M, Suzuki T, Yoshida H et al. Joint space narrowing, body mass index, and knee pain: The road study (oac1839r1). Osteoarthritis Cartilage. 2015;23:874-81.
- Yang ZY, Chen W, Li CX, Wang J, Shao DC, Hou ZY et al. Medial compartment decompression by fibular osteotomy to treat medial compartment knee osteoarthritis: A pilot study. Orthopedics. 2015;38:e1110-4.
- Roos EM, Juhl CB. Osteoarthritis 2012 year in review: Rehabilitation and outcomes. Osteoarthritis Cartilage. 2012;20:1477-83.
- Paik RS, Kim BS. Editorial commentary: Risk of lateral hinge fracture after knee medial opening-wedge high tibial osteotomy can be reduced with osteotomy at the level of the proximal tibiofibular joint and gap width of no larger than 11 mm. Arthroscopy. 2024;40:896-7.
- Kang T, Lee DW, Park JY, Han HS, Lee MC, Ro DH. Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury. Knee Surg Sports Traumatol Arthrosc. 2020;28:1365-71.
- Itou J, Itoh M, Maruki C, Tajimi T, So T, Kuwashima U, et al. Deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2020;28:1372-9.
- Schnurr C, Jarrous M, Güdden I, Eysel P, König DP. Pre-operative arthritis severity as a predictor for total knee arthroplasty patients' satisfaction. Int Orthop. 2013;37:1257-61.
- Zhang YZ. Innovations in orthopedics and traumatology in china. Chin Med J (Engl.). 2015;128:2841-2.
- Wu ZX, Ren WX, Wang ZQ. Proximal fibular osteotomy versus high tibial osteotomy for treating knee osteoarthritis: A systematic review and meta-analysis. J Orthop Surg Res. 2022;17:470.
- Yu J, Wu P, Guo H, Chen P, Yuwen P, Wang J et al. Proximal tibial osteotomy with absorbable spacer combined with fibular osteotomy has similar clinical outcomes to high tibial osteotomy in the treatment of knee osteoarthritis. Int Orthop. 2023;47:2699-708.
- Liang ZJ, Koh DTS, Soong J, Lee KH, Bin Abd Razak HR. Severity of knee osteoarthritis does not affect clinical outcomes following proximal fibular osteotomy - a systematic review and pooled analysis. J Clin Orthop Trauma. 2024;54:102473.
- Atlıhan D, Günaydın F, Muslu DC. Effects of proximal fibular partial excision on medial compartment knee osteoarthritis. Int. Orthop. 2022;46:2251-6.
- Wang X, Wei L, Lv Z, Zhao B, Duan Z, Wu W et al. Proximal fibular osteotomy: A new surgery for pain relief and improvement of joint function in patients with knee osteoarthritis. J Int Med Res. 2017;45:282-9.
- Utomo DN, Mahyudin F, Wijaya AM, Widhiyanto L. Proximal fibula osteotomy as an alternative to tka and hto in late-stage varus type of knee osteoarthritis. J Orthop. 2018;15:858-61.
- Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N. Engl. J. Med. 2008;359:1097-107.
- Qin D, Chen W, Wang J, Lv H, Ma W, Dong T et al. Mechanism and influencing factors of proximal fibular osteotomy for treatment of medial compartment knee osteoarthritis: A prospective study. J Int Med Res. 2018;46:3114-23.
- Huda N, Islam MSU, Kumar H, Pant A, Bishnoi S. Proximal fibular osteotomy for medial compartment knee osteoarthritis: Is it worth? Indian J Orthop. 2020;54:47-51.
- Prakash L, Dhar SA. Proximal fibular osteotomy: Biomechanics, indications, technique, and results. Orthopedics. 2020;43:e627-e31.
- Wang YM, Zhu C, Kong R, Yu DW, Zhao QC. Effect of partial fibula osteotomy combined with arthroscopic debridement surgery in the treatment of medial compartment knee osteoarthritis. J Knee Surg. 2020;33:728-31.
- Ogbemudia AO, Umebese PF, Bafor A, Igbinovia E, Ogbemudia PE. The level of fibula osteotomy and incidence of peroneal nerve palsy in proximal tibial osteotomy. J Surg Tech Case Rep. 2010;2:17-9.
Öz
Öz
Amaç: Bu çalışmanın amacı, medial kompartman diz osteoartriti (MKDOA) olan hastalarda artroskopik debridman (AD) ile kombine edilen proksimal fibula osteotomisi (PFO) ile yalnızca artroskopik debridman uygulanan hastaların klinik ve radyolojik sonuçlarını karşılaştırmaktır.
Gereç ve Yöntem: Bu retrospektif çalışma, Mayıs 2019 ile Ocak 2023 tarihleri arasında hastanemizde tedavi edilen MKDOA tanılı 74 hastaya ait 85 dizi kapsamaktadır. Grup I, yalnızca AD uygulanan 44 dizi; Grup II ise PFO + AD uygulanan 41 dizi içermektedir. Her iki grupta da preoperatif ve postoperatif klinik ve radyolojik parametreler değerlendirildi. Gruplar arasında postoperatif sonuçlar ve komplikasyon oranları karşılaştırıldı.
Bulgular: Postoperatif ortalama ağrı skorları (VAS), Grup II'de (3.21 ± 2.04), Grup I'e (6.45 ± 1.62) göre anlamlı olarak düşüktü. Postoperatif ortalama Oxford Diz Skoru, Grup II'de (33.26 ± 7.38), Grup I'e (27.14 ± 5.61) kıyasla anlamlı olarak yüksekti. Ayrıca, postoperatif radyolojik parametreler (medial eklem aralığı, lateral eklem aralığı ve eklem aralığı oranı) Grup II'de Grup I'e kıyasla anlamlı ölçüde daha iyiydi.
Sonuç: AD ile kombine edilen PFO, MKDOA tedavisinde etkili bir seçenek olup, düşük komplikasyon oranıyla hem klinik hem de radyolojik iyileşme sağlamaktadır.
Anahtar Kelimeler
Artroskopik debridman diz osteoartriti Oxford Diz Skoru proksimal fibula osteotomisi
Kaynakça
- Bashekah KA, Zagzoug ME, Banaja AW, Alghamdi AA, Mishiming OS, Jan MA et al. Prevalence and characteristics of knee osteoarthritis among the general public in saudi arabia. Cureus. 2023;15:e47666.
- Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. E ClinicalMedicine. 2020;29-30:100587.
- Yang G, Wang J, Liu Y, Lu H, He L, Ma C et al. Burden of knee osteoarthritis in 204 countries and territories, 1990-2019: Results from the global burden of disease study 2019. Arthritis Care Res (Hoboken). 2023;75:2489-500.
- Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59:1207-13.
- Muraki S, Akune T, En-Yo Y, Yoshida M, Suzuki T, Yoshida H et al. Joint space narrowing, body mass index, and knee pain: The road study (oac1839r1). Osteoarthritis Cartilage. 2015;23:874-81.
- Yang ZY, Chen W, Li CX, Wang J, Shao DC, Hou ZY et al. Medial compartment decompression by fibular osteotomy to treat medial compartment knee osteoarthritis: A pilot study. Orthopedics. 2015;38:e1110-4.
- Roos EM, Juhl CB. Osteoarthritis 2012 year in review: Rehabilitation and outcomes. Osteoarthritis Cartilage. 2012;20:1477-83.
- Paik RS, Kim BS. Editorial commentary: Risk of lateral hinge fracture after knee medial opening-wedge high tibial osteotomy can be reduced with osteotomy at the level of the proximal tibiofibular joint and gap width of no larger than 11 mm. Arthroscopy. 2024;40:896-7.
- Kang T, Lee DW, Park JY, Han HS, Lee MC, Ro DH. Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury. Knee Surg Sports Traumatol Arthrosc. 2020;28:1365-71.
- Itou J, Itoh M, Maruki C, Tajimi T, So T, Kuwashima U, et al. Deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2020;28:1372-9.
- Schnurr C, Jarrous M, Güdden I, Eysel P, König DP. Pre-operative arthritis severity as a predictor for total knee arthroplasty patients' satisfaction. Int Orthop. 2013;37:1257-61.
- Zhang YZ. Innovations in orthopedics and traumatology in china. Chin Med J (Engl.). 2015;128:2841-2.
- Wu ZX, Ren WX, Wang ZQ. Proximal fibular osteotomy versus high tibial osteotomy for treating knee osteoarthritis: A systematic review and meta-analysis. J Orthop Surg Res. 2022;17:470.
- Yu J, Wu P, Guo H, Chen P, Yuwen P, Wang J et al. Proximal tibial osteotomy with absorbable spacer combined with fibular osteotomy has similar clinical outcomes to high tibial osteotomy in the treatment of knee osteoarthritis. Int Orthop. 2023;47:2699-708.
- Liang ZJ, Koh DTS, Soong J, Lee KH, Bin Abd Razak HR. Severity of knee osteoarthritis does not affect clinical outcomes following proximal fibular osteotomy - a systematic review and pooled analysis. J Clin Orthop Trauma. 2024;54:102473.
- Atlıhan D, Günaydın F, Muslu DC. Effects of proximal fibular partial excision on medial compartment knee osteoarthritis. Int. Orthop. 2022;46:2251-6.
- Wang X, Wei L, Lv Z, Zhao B, Duan Z, Wu W et al. Proximal fibular osteotomy: A new surgery for pain relief and improvement of joint function in patients with knee osteoarthritis. J Int Med Res. 2017;45:282-9.
- Utomo DN, Mahyudin F, Wijaya AM, Widhiyanto L. Proximal fibula osteotomy as an alternative to tka and hto in late-stage varus type of knee osteoarthritis. J Orthop. 2018;15:858-61.
- Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N. Engl. J. Med. 2008;359:1097-107.
- Qin D, Chen W, Wang J, Lv H, Ma W, Dong T et al. Mechanism and influencing factors of proximal fibular osteotomy for treatment of medial compartment knee osteoarthritis: A prospective study. J Int Med Res. 2018;46:3114-23.
- Huda N, Islam MSU, Kumar H, Pant A, Bishnoi S. Proximal fibular osteotomy for medial compartment knee osteoarthritis: Is it worth? Indian J Orthop. 2020;54:47-51.
- Prakash L, Dhar SA. Proximal fibular osteotomy: Biomechanics, indications, technique, and results. Orthopedics. 2020;43:e627-e31.
- Wang YM, Zhu C, Kong R, Yu DW, Zhao QC. Effect of partial fibula osteotomy combined with arthroscopic debridement surgery in the treatment of medial compartment knee osteoarthritis. J Knee Surg. 2020;33:728-31.
- Ogbemudia AO, Umebese PF, Bafor A, Igbinovia E, Ogbemudia PE. The level of fibula osteotomy and incidence of peroneal nerve palsy in proximal tibial osteotomy. J Surg Tech Case Rep. 2010;2:17-9.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Ortopedi |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2025 |
| Gönderilme Tarihi | 20 Kasım 2024 |
| Kabul Tarihi | 16 Nisan 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 50 Sayı: 2 |
