Proximal Fibular Osteotomy Vs Proximal Fibular Osteotomy with Intra-Articular Hyaluronic Acid: Difference in Terms of Pain Relief and Functional Outcome
DOI:
https://doi.org/10.36283/PJMD13-1/017Keywords:
Intra-Articular Injection, Knee osteoarthritis, Osteoarthritis, OsteotomyAbstract
Background: Knee osteoarthritis (OA) is a complex, progressive illness marked by cartilage deterioration and adjacent bone enlargement, and management is challenging due to poor connective tissue self-regeneration. This study compared the effects of proximal fibular osteotomy (PFO) alone versus PFO with intra-articular hyaluronic acid injections (IAHA) among patients presenting with knee OA.
Methods: A quasi-experimental study was done at Ziauddin Hospital's orthopedics department from March 2020 to March 2021. Patients with medial compartment knee joint OA requiring surgery aged≥40 years and BMI of <30kg/m2 were included. All participants were assigned into two groups, PFO was done alone in group A (n=30) and with IAHA in group B (n=30). Both groups had their medial joint spaces measured and documented pre- and post-operatively, as well as their Oxford knee score and visual analog scale (VAS). SPSS version 25 was used and the normality of data was assessed using Shapiro-Wilk’s test. The mean difference (post-pre) was compared using the Mann-Whitney U test. A p≤0.05 was statistically significant.
Results: A total of 60 patients were included with a mean age of 51.30±4.87 in Group A and 50.83±6.17 in Group B. Outcomes in both groups were improved considerably with a significant p<0.0001 in groups, in terms of pain and function determined using Oxford knee score, medial joint space measurement, and VAS score.
Conclusion: PFO alone and PFO with IAHA show significantly improved results in terms of functional outcomes, but the use of IAHA in combination with PFO, has considerably better results in terms of pain relief.
References
Hsu H, Siwiec RM. Knee Osteoarthritis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
Primorac D, Molnar V, Rod E, Jeleč Ž, Čukelj F, Matišić V, et al. Knee Osteoarthritis: A Review of Pathogenesis and State-Of-The-Art Non-Operative Therapeutic Considerations. Genes. 2020;11(8):854
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. eClinicalMedicine. 2020;29 DOI: 10.1016/j.eclinm.2020.100587
Ravalli S, Pulici C, Binetti S, Aglieco A, Vecchio M, Musumeci G. An Overview of the Pathogenesis and Treatment of Elbow Osteoarthritis. Journal of Functional Morphology and Kinesiology. 2019;4(2):30
Varacallo M, Luo TD, Johanson NA. Total Knee Arthroplasty Techniques. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
Beckmann J, Meier MK, Benignus C, Hecker A, Thienpont E. Contemporary knee arthroplasty: one fits all or time for diversity? Arch Orthop Trauma Surg. 2021;141(12):2185-2194 DOI: 10.1007/s00402-021-04042-4
Laprade RF, Spiridonov SI, Nystrom LM, Jansson KS. Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy. Arthroscopy: The Journal of Arthroscopic & related Surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2012;28(3):354-364 DOI: 10.1016/j.arthro.2011.08.310
Seo SS, Nha KW, Kim TY, Shin YS. Survival of total knee arthroplasty after high tibial osteotomy versus primary total knee arthroplasty: A meta-analysis. Medicine (Baltimore). 2019;98(30):e16609 DOI: 10.1097/md.0000000000016609
Rai A, Saurabh A, Shekhar S, Kunwar A, Verma V. Proximal fibular osteotomy for pain relief and functional improvement in patients of osteoarthritis of knee. International Surgery Journal. 2019;6:2368 DOI: 10.18203/2349-2902.isj20192957
Kakumanu R, Kunadharaju R, Ganesh C. Prospective study of functional and radiological outcome of proximal fibular osteotomy for medial compartment osteoarthritis in elderly. Journal of Orthopaedic Diseases and Traumatology. 2021;4(3):86-91 DOI: 10.4103/jodp.jodp_13_21
Vaish A, Kumar Kathiriya Y, Vaishya R. A Critical Review of Proximal Fibular Osteotomy for Knee Osteoarthritis. The archives of bone and joint surgery. 2019;7(5):453-462
Bhandari M, Bannuru RR, Babins EM, Martel-Pelletier J, Khan M, Raynauld JP, et al. Intra-articular hyaluronic acid in the treatment of knee osteoarthritis: a Canadian evidence-based perspective. Ther Adv Musculoskelet Dis. 2017;9(9):231-246 DOI: 10.1177/1759720x17729641
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(1):282-289 DOI: 10.1177/0300060516676630
Yang Z-Y, Chen W, Li C-X, Wang J, Shao D-C, Hou Z-Y, et al. Medial compartment decompression by fibular osteotomy to treat medial compartment knee osteoarthritis: a pilot study. Orthopedics. 2015;38(12):e1110-e4
Zheng Z, Sun Y, Zhang X, Chen W, Li S, Zhang Y. The pathogenesis and clinical imageology research of the knee osteoarthritis. J Hebei Med Univ. 2014;35(5):599-600
Shanmugasundaram S, Kambhampati SB, Saseendar S. Proximal fibular osteotomy in the treatment of medial osteoarthritis of the knee–A narrative review of literature. Knee Surgery & Related Research. 2019;31(1):1-7
Emami A, Tepper J, Short B, Yaksh TL, Bendele AM, Ramani T, et al. Toxicology evaluation of drugs administered via uncommon routes: intranasal, intraocular, intrathecal/intraspinal, and intra-articular. International journal of toxicology. 2018;37(1):4-27
Cao Y, Ma Y, Tao Y, Lin W, Wang P. Intra-Articular Drug Delivery for Osteoarthritis Treatment. Pharmaceutics. 2021;13(12) DOI: 10.3390/pharmaceutics13122166
Huang H, Lou Z, Zheng S, Wu J, Yao Q, Chen R, et al. Intra-articular drug delivery systems for osteoarthritis therapy: shifting from sustained release to enhancing penetration into cartilage. Drug Deliv. 2022;29(1):767-791 DOI: 10.1080/10717544.2022.2048130
McIntyre LF, Bhattacharyya S, Yadalam S, Bisson B, Kim M. Impact of hyaluronic acid injections on utilization of pain management medications. Am J Pharm Benefits. 2017;9(6):195-199
Mar J, Jurado MR, Arrospide A, Fidalgo AE, Lopez BS. Cost-analysis of viscosupplementation treatment with hyaluronic acid in candidate knee replacement patients with osteoarthritis. Revista Española de Cirugía Ortopédica y Traumatología (English Edition). 2013;57(1):6-14
Delbarre A, Amor B, Bardoulat I, Tetafort A, Pelletier-Fleury N. Do intra-articular hyaluronic acid injections delay total knee replacement in patients with osteoarthritis–a Cox model analysis. PLoS One. 2017;12(11):e0187227
Altman RD, Bedi A, Karlsson J, Sancheti P, Schemitsch E. Product differences in intra-articular hyaluronic acids for osteoarthritis of the knee. The American journal of sports medicine. 2016;44(8):215821-65
Zou G, Lan W, Zeng Y, Xie J, Chen S, Qiu Y. Early clinical effect of proximal fibular osteotomy on knee osteoarthritis. Biomedical Research (0970-938X). 2017;28(21)
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(12):e1110-1114 DOI: 10.3928/01477447-20151120-08
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Pakistan Journal of Medicine and Dentistry
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/
