PROXIMAL FIBULAR OSTEOTOMY
By altering the biomechanics of the knee through fibular osteotomy, the load distribution on the knee joint can be modified, potentially providing relief from pain and improving function. It’s a surgical option considered in specific cases to address knee issues and delay the progression of arthritis.
When there is a complete collapse of the medial compartment of the knee joint the weight bearing becomes concentrated in the medial compartment of the knee joint. By this small surgical procedure PROXIMAL FIBULAR OSTEOTOMY (PFO). The medial compartment opens up and there is a re-distribution of weight to the whole surface of the tibia (shin bone). There is immense relief of knee pain and de-stressing to hasten up the cartilage regeneration process.
FAQ PROXIMAL FIBULAR OSTEOTOMY (PFO)?
Q.1. What if PROXIMAL FIBULAR OSTEOTOMY (PFO)?
Ans.1. Proximal fibular osteotomy: a new surgery for pain relief and improvement of joint function in patients with knee osteoarthritis (OA)>
Q.2. Who are the patients to get the best benefit of PFO?
Ans.2. PFO is the treatment of choice for patients where there is a complete collapse of the medial compartment on X-rays.
Q.3. What are the advantages of PFO over total knee replacement (TKR)?
Ans.3. Total knee arthroplasty (TKA), which aims to relieve pain and improve joint function and mobility. However, TKA is expensive and complex, and some patients need a second knee revision after the first surgery.
It is the main surgical alternative in this patient population who do not want complex and expensive surgery. Or due to co-existing medical conditions make them unfit for long and extensive surgery.
The PFO relieves pain and improves joint function in knee OA.
This new surgery is simple, safe, and affordable. This needs one day of hospitalization.
Pain relief after surgery occurs in almost all patients. PFO may delay or replace TKA in properly selected patients suffering from knee OA.
The PFO is a simple, safe, fast, and affordable surgery to relieve pain and improve joint function and the medial joint space in human knee osteoarthritis.
Q.4. What is the mechanism of pain relief after PFO?
Ans.4. The mechanism of pain relief and joint space improvement after proximal fibular osteotomy.
In a normal knee joint, both compartments are equal joint space is nicely maintained and equal loads are distributed on the medial and lateral tibia plateau. In OA due to cartilage degradation and collapse a greater load was shifted to the medial tibia plateau.
The proximal fibular osteotomy corrects the abnormal load bearing on the collapsed compartment thereby offloading the cartilage so that it has a chance to regenerate.
Q.5. Can the PFO be combined with other procedures?
Ans.5. The PFO can be combined with PRP therapy and Video – arthroscopy where indicated in a single session. Depending on the stage of degeneration.
For Example:
The protocol that is followed as per findings and investigation :
1.) OA changes to mild to severe pain with no history of locking sensation in the knee joint – PRP therapy is indicated
2.) OA changes mild to severe pain with a history of locking sensation in the knee joint – PRP therapy in combination with video-arthroscopic Menisectomy/ debridement in a single session is indicated.
3.) OA changes mild to severe pain with a history of locking sensation in the knee joint and additional finding of the completely collapsed medial compartment – PRP therapy in combination with video-arthroscopic Menisectomy/ debridement and Proximal fibular osteotomy (PFO) can be done in a single session.
In summary, our preliminary data clearly demonstrate that PFO may be a promising alternative in most developing countries because of their financial and healthcare delivery limitations. It may also constitute a promising alternative surgery for osteoarthritis of the medial compartment of the knee, especially for patients who cannot undergo TKA because of certain medical comorbidities. Furthermore, these patients can still undergo TKA in the future if it becomes necessary.