PFO : PROXIMAL FIBULAR

OSTEOTOMY
( A magical operation in medial
compartment osteoarthritis of knee
joint)

SPEAKER : DR. BIJAYENDRA NATH

CHATURVEDI
MS ORTHOPEDICS (Std.)
PATNA MEDICAL COLLEGE, PATNA
OVERVIEW
• Knee OA : chronic, progressive degenerative
disease with accompanying joint pain,
stiffness, and deformity

• Variety of procedures have been described

for treatment of the osteoarthritis

• The choice of procedure depends on the

patients’ age, activity expectations and
severity of the disease
PFO…..

• Simple

• Safe

• Affordable

• Day- care surgery

• Indication : mild to moderate

osteoarthritis of knee joint
 BASIS OF PFO

• The current belief is that the load

is distributed along the
mechanical axis, which is
generally medial to the centre of
the knee

• The lateral support provided to the

osteoporotic tibia by the fibula–
soft tissue complex may lead to
the nonuniform settlement and
degeneration of the plateau
bilaterally
• The load from the normal
distribution shifting further
medially to the medial
plateau and consequently
leads to knee varus,
aggravating the progression
of medial compartment OA of
the knee joint

• PFO relieves the increased

loading force on the medial
compartment
 AIMS OF PFO

• Pain relief

• Improvement of medical
joint space

• Improvement of joint
function
 MATERIALS AND METHODS

• Duration of study : May 2016 to

February, 2018

• Place of study : Patna Medical

College and Hospital, Patna

• A total of 32 patients (n=32)

underwent PFO and were
followed prospectively

• Mean Age = 56.238±7.88 (range

= 48 to 72 years) including 18
females and 14 males.
• An approximately 5 centimeter
longitudinal incision was made over
the posterolateral skin of the proximal
part of the leg

• Fibula was exposed between the

peroneus (longus and brevis )
muscles and soleus muscle

• PFO was perfomed by removing a

approximately 2 cm length of fibula at
a length of 6 cm below the fibular
head

• One should be cautious about

peroneal nerve injury .
 RESULTS

• Total 32 patients underwent PFO

• 4 patients were lost to follow –up

• 28 patients were followed for a minimum of

12 month

• The mean duration of follow – up was 14 .44

months (Range 12 -17Months )

• The average duration of bilateral PFO was

38 +/- 10minutes .
• No post operative complications were observed

• Relief of pain in medial compartment was observed

in almost all patients

• Mean Visual Analogue Scale ( VAS ) score significantly

decreased from 7.9+-1.45 preoperatively to
2.69+- 2.24 post operatively

• American Knee Society Score improved from

40.94 +/- 12.69 to 65.76 +/- 12.26
• Knee function score from 42.41 +/- 8.5
to 68.63 +/- 12.66

• Obvious improvement in the joint

space ratio
(Medial /Lateral compartment )

• Obvious correction of alignment

( Hip-Knee –Ankle)
TAKE HOME MESSAGE :
• PFO may be a promising alternative
surgery in developing countries like India
because of their financial and healthcare
delivery limitations

• It may be used as an alternative surgery

for patients of Osteoarthritis who cannot
undergo TKA because of certain medical
comorbidities.
THANK YOU