Abstract :
Background: Osteoarthritis (OA) of the knee is an emerging cause of morbidity and indirect mortality encountered by the clinician. Failure to respond to conservative management is common and surgery is the usual outcome. Total Knee arthroplasty (TKA) and Unicondylar knee arthroplasty (UKA) have displayed dependable results but are demanding surgeries with a limited lifespan. High tibial osteotomy (HTO) corrects the alignment of the limb and improve knee function but is associated with a series of complications and difficult conversion. Recent studies on Proximal Femoral Osteotomy (PFO) in medial OA of the knee proclaim much relief in pain and correction of limb alignment. We conducted a prospective interventional study to evaluate the functional and radiological outcome of PFO in medial OA knee.
Materials and Methods: 18 patients (30 knees) of medial OA knee with Kellgren Lawrence (KL) grade 2 and 3 disease underwent PFO after written informed consent and institutional review board clearance. The patients were followed up at 3 months, 6 months and 1 year and Femoro-Tibial angle (FTA), Visual Analogue Score (VAS), Knee injury and Osteoarthritis Outcome score (KOOS) and Oxford Knee Score (OKS) were documented pre-operatively and at each follow up.
Result: The mean age in our study was 64 years. The mean VAS score was 6.86 pre-operatively while 3-month VAS was 6.96 and its 12 month value was 7.26 The mean pre-operative OKS was 34.26 which decreased to 33.36 at 3 months and 32.26 at 12 months. The mean pre-operative KOOS was 52.99 while it was 51.88 at 3 months and worsened to 50.98 at the final follow up. The mean FTA pre operatively was 182.96 degree and at 1 year follow up it deteriorated to 183.26 degree. 3 patients (10%) informed paresthesias and weakness in the foot which resolved on medical management.
Conclusion: We did not observe relief in pain and function after PFO. The limb alignment did not improve at 1 year follow up. The authors conclude that more evidence needs to be gathered before validating PFO as an established treatment modality in medial OA knee.
Keyword :
Arthritis, Knee, Osteoarthritis, PFO, Osteotomy.