Introduction
Osteoarthrosis
is a degenerative joint condition characterized by progressive loss of
articular cartilage, marginal
bone hypertrophy (osteophytes) and changes in the synovial membrane, where
the inflammatory component plays a fundamental role. This condition is very
frequent at present, statistical data reveals that 12% of the population of the
United States is affected by this disease and represents around 27 million
people with an annual expenditure of 90 billion dollars. It is characterized by
mechanical pain that is often associated with stiffness and progressively leads
to loss or decrease in joint function. It is a systemic, multifactorial,
prevalent, progressive and incurable disease [1-3].
The knee joint is one
of the most affected by this disease and is often accompanied by angular
deformities, especially varus. Under normal conditions, 60 to 80% of the weight
load is distributed in the medial compartment of the knee. Hence, this
compartment is considered the starting site of the disease and its condition is
also a factor of progression [1,2,4].
Most of the carriers of
this pathology present to the consultation with intense and intermittent or
continuous pain, mobility disorders, deformity and joint instability. All of
the above causes both physical and psychological affection of the patient by
affecting their quality of life. For the treatment of Knee
Osteoarthritis (KO) with Varus Angular Deformity (VAD), there are a number
of treatment variants, especially surgical ones where they are found: osteotomies,
Unicompartmental
Arthroplasties (UA) and Total Knee (TK).
However, each of these
procedures have specific indications, which limit their indication, for
example, osteotomies, among other elements, require good bone quality and are
performed in patients generally under 60 years of age. UA and TK are not
available at every moment due to its complexity and cost. Hence the need for an
alternative method, for the treatment of patients with VAD, such as Partial
Fibular Ostectomy (PFO) [2,4].
PFO is a new surgical
technique initiated by Professors Yang Zong-You, Ying Ze Zhang and their group
of collaborators, who perform a proximal fibula ostectomy of approximately 2
centimeters, carried out between 6 and 10 centimeters below the head of the
fibula, with the purpose of decompressing the internal compartment into the
genu painful varus and in this way alleviating the patient's pain, improving
the function and gait of the patient with minimal resources and a faster
recovery thereof. Surgical indications for performing PFO are the same as for
osteotomy except for age and bone characteristics, since osteotomy requires
good bone quality on the part of the patient, hence PFO is a useful variant in
patients with KO and VAD of 60 years of age or more, which due to the age
element is not feasible to perform the osteotomy. PFO is a technically
undemanding procedure, it does not have complications related to osteotomy and
it allows the support of body weight immediately [4-6].
Yang ZY, et al, as a
result of their research in 110 patients with more than two years of follow-up,
found that OPP decreases pain (according to the SAV: visual analog scale) in
patients with KO and VAD, improves radiographic appearance (tibiofemoral angle
and lateral joint space) and joint function based on the American Knee Society
Score, which delays or cancels the need for a TK. Hence, this author considered
this method as safe, simple and effective [5].
In Cuba, the medical
team of Dr. Enreque Pancorbo, who is also a second degree specialist in
Orthopedics and head of the orthopedics and traumatology specialty of the Mario
Muñoz military hospital in the city of Matanzas, began to apply this method
since April 2016, until 2018 108 patients, 43 men and 65 women passed through
the rooms; between the ages of 50 to 84, with an average life span of one
hundred people of 65.4 years. The improvement in clinical symptoms, among which
pain stands out, was almost immediate in these patients. In the opinion of the
specialist, the use of this simple, practical and economic surgical method,
without the expense of large material resources, is feasible to improve the
quality of life of patients and their families. As KO is a chronic degenerative
disease, it is not eliminated with the aforementioned surgical procedure, but
it has been shown that it is possible to distribute the weight load between the
two compartments of the knee, thereby eliminating pain. PFO reduces costs by
early incorporating the affected person into their activities, improves the
quality of life for him and his family, can be applied to both sexes, reduces
knee deformity and has a positive impact on the social and economic aspects
[7].
Although this surgical
technique does not eliminate osteoarthritis of the knee, it does improve the
symptoms and the functional incapacity of the joint almost from the moment of
the surgical
intervention. Since 2018, a project on the application of the fibula
ostectomy technique described by Dr. Yang has been running at the
"Mártires del 9 de Abril" General Teaching Hospital in Sagua la
Grande, Villa Clara province, Cuba. ZY, et al, in patients older than 60 years
with a diagnosis of KO and VAD, which hopes to demonstrate the effectiveness of
this technique for improving the clinical symptoms of these patients [5].
After the age of 60,
the surgical possibilities of patients with this diagnosis decrease, generally
this is an age in which several concomitant chronic diseases tend to appear,
which limit the therapeutic options to be used. In these cases, fibular ostectomy
continues to be a good option to consider. Fibula
ostectomy is a palliative treatment of choice in knee osteoarthritis.
References
1. Pancorbo SEA,
Ceballos MA, Martín TJC, Quesada PJ, Cruz AR, et al. Fibula osteotomy, a new
surgical technique in painful genu varus Proceed and presentation of two cases
(2017) Rev Med Electron 39: 966-974.
2. Guyen PT, Alvarez LA
and Aquino MFD. Partial fibular ostectomy and arthroscopy in medial knee
osteoarthritis with varus deformity (2018) AMC 22: 244-251.
3. Cartas US, Hernandez
DMP, Rodriguez CM, Armas HA, Gonzalez VG, et al. Demographic traits in knee
osteoarthritis (2015) Cuban J Rheumatol 17: 32-39.
4. Lopez Pereira MA.
Inverted v valgus osteotomy for the correction of the genuvarum with
unicompartmental knee osteoarthritis (2010) In Annals Faculty Med Sci 43:
31-42.
5. Zhang YZ.
Innovations in orthopedics and traumatology in china (2015) Chinese Med J 128:
2841-2842. https://doi.org/10.4103/0366-6999.168015
6. Yang ZY, Chen W, Li
CX, Wang J, Shao DC, et al. Medial compartment decompression by fibular
osteotomy to treat medial compartment knee osteoarthritis: a pilot study (2015)
Orthopedics 38: 1110-1114. https://doi.org/10.3928/01477447-20151120-08
7. Free health and
qualified personnel, rights of Cubans.
*Corresponding author
Claribel Plain Pazos, Faculty of Medical
Sciences of Sagua la Grande, Villa Clara, Cuba, Email: claribelpp@infomed.sld.cu
Citation
Gonzalez JCC, Plain LD, Pazos CP, Pineiro SM, Plain APA, et al. Fibula ostectomy as palliative treatment of knee osteoatrosis (2020) Edel J Biomed Res Rev 2: 36-37.Keywords
Osteoarthritis, Knee pain, Ostectomy of fibula.