Proximal Fibular Osteotomy in Medial Compartment Knee Osteoarthritis

Proximal fibular osteotomy (PFO) has emerged as a minimally invasive surgical approach to alleviate pain and improve function in patients with medial compartment knee osteoarthritis characterised by varus alignment. By removing a short segment of the fibula just below its head, PFO reduces lateral support of the tibial plateau and allows redistribution of load from the overloaded medial compartment towards the lateral side. Clinical series and observational studies report rapid relief of pain, improvement in knee scores and correction of varus deformity in early to moderate disease, often with shorter operative time, reduced bleeding and fewer complications than high tibial osteotomy. Biomechanical investigations using finite element and gait-analysis models demonstrate marked reduction in medial cartilage and meniscal stress, a shift in the centre of pressure and decreases in knee adduction moment. This cost-effective procedure may be particularly valuable in resource-limited settings or for patients unable to tolerate more extensive realignment surgeries. Long-term comparative trials and detailed patient-selection criteria are under development to refine indications and optimise outcomes.

Research from Nature Portfolio

Recent studies have investigated changes in lower-limb alignment and functional outcomes after vascularised fibula graft harvest, a procedure sharing biomechanical principles with PFO in varus gonarthrosis. Mid-term follow-up indicates negligible differences in knee inclination and ankle clear space when comparing operated and contralateral limbs, yet a modest improvement in hip-knee-ankle angle towards neutral alignment. Patient-reported scores reveal satisfactory or excellent knee function on the operated side, although slightly lower than in the healthy limb. These findings underscore the importance of careful surgical technique and suggest that procedures modifying fibular support can achieve meaningful realignment without compromising joint stability.

Proximal Fibular Osteotomy in Medial Compartment Knee Osteoarthritis publication trend

The graph below shows the total number of articles in proximal fibular osteotomy in medial compartment knee osteoarthritis across all publications each year (not limited to Nature Index journals).

Technical terms

Proximal fibular osteotomy (PFO): Surgical removal of a segment of the fibula head to redistribute knee joint load.

Varus deformity: Inward angulation of the knee causing increased medial load.

Finite element analysis (FEA): Computational method to predict stress and strain in biomechanical models.

Hip-knee-ankle (HKA) angle: Radiographic measure of coronal limb alignment between hip, knee and ankle centre points.

Contact pressure: Force per unit area at the cartilage interface within the knee joint.

References

1. Stress Effect in the Knee Joint Based on the Fibular Osteotomy Level and Varus Deformity: A Finite Element Analysis Study. Bioengineering (2023).
2. Evaluation of the effect of vascularized fibula graft harvesting on coronal plane alignment and functional outcomes of the lower limb. Scientific Reports (2024).
3. Anatomical basis of the support of fibula to tibial plateau and its clinical significance. Journal of Orthopaedic Surgery and Research (2021).
4. Proximal fibular osteotomy versus high tibial osteotomy for treating knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research (2022).
5. In-silico study of the biomechanical effects of proximal-fibular osteotomy on knee joint contact pressure in varus-valgus misalignment. Medical Engineering & Physics (2024).