Journal of Family Medicine and Primary Care

LETTER TO EDITOR
Year
: 2021  |  Volume : 10  |  Issue : 2  |  Page : 1064--1065

Jayanta K. Laik. Proximal fibular osteotomy: Alternative approach with medial compartment osteoarthritis knee- Indian context


Luis Antonio Goytia Alfaro1, Prasanth Gopal2,  
1 Department of Orthopedic Surgery, University Health Insurance Hospital and Cristo de las Americas Hospital, Sucre, Bolivia
2 Department of Orthopedics, Trichy SRM Medical College and Research Institute, Tamil Nadu, India

Correspondence Address:
Dr. Prasanth Gopal
Department of Orthopaedics, Trichy SRM Medical College and Research Institute, Irungalur, Trichy – 621 105, Tamil Nadu
India




How to cite this article:
Alfaro LG, Gopal P. Jayanta K. Laik. Proximal fibular osteotomy: Alternative approach with medial compartment osteoarthritis knee- Indian context.J Family Med Prim Care 2021;10:1064-1065


How to cite this URL:
Alfaro LG, Gopal P. Jayanta K. Laik. Proximal fibular osteotomy: Alternative approach with medial compartment osteoarthritis knee- Indian context. J Family Med Prim Care [serial online] 2021 [cited 2021 May 15 ];10:1064-1065
Available from: https://www.jfmpc.com/text.asp?2021/10/2/1064/310303


Full Text



Dear Editor,

First, we would like to congratulate Laik JK et al. for their creditable research that that has been published in your journal.[1] Their prospective, interventional cohort study definitely adds to existing knowledge on this relatively new and cost-effective treatment method.

The positives of the study include clear inclusion and exclusion criteria, use of established outcome measures (VAS, Tegner Lysholm score, medial joint space and femoro-tibial angle) and clearly established surgical protocol for standardization of the treatment and measurement of clinical outcomes. The sample size, though small, helps to understand the outcomes prospectively.

Though the authors have mentioned the sample size to be 30 patients, the actual numbers appear to be 27 patients (30 knees) with three patients undergoing bilateral surgery. This could have been clarified better. Moreover, osteoarthritis of the knee being a chronic condition, it is important to assess the long-term outcomes in addition to the short-term gains. A follow-up of a minimum of two years in all the patients could add more value to the findings of the study.

We would also like to take this opportunity to stress upon readers the fact that proximal fibular osteotomy should not be considered a one-stop solution for all patients with medial knee osteoarthritis. The indications and predictors of good outcomes have been discussed in detail in systematic reviews on this topic. That said, the mechanisms proposed are multiple, also implying that the procedure and its mechanisms are still being understood.[2]

The risk of injury to the superficial and deep peroneal nerves in relation to the proximal fibula is known.[3],[4] Hence, we stress on an incision 6 cm below the fibular head and downwards and also approaching the fibula posterior to the coronal plane to avoid the peroneal nerve and its branches which are anterior to the coronal plane. Hence a posterolateral approach between the peroneus longus and brevis muscle is advisable instead of a direct lateral approach.[2],[3],[5]

We would also like to cite the work of Vaish et al. where the authors have provided a detailed description of the recommended surgical technique in order to prevent injury to the superficial and deep peroneal nerves.

There is no doubt that this could be a useful method to treat osteoarthritis of the knee and prevent its early progression to a total knee arthroplasty, when performed for the right patients. However, to get to this point there is still a large way to go in the form of establishing strong evidence.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Laik JK, Kaushal R, Kumar R, Sarkar S, Garg M. Proximal fibular osteotomy: Alternative approach with medial compartment osteoarthritis knee – Indian context. J Family Med Prim Care 2020;9:2364-9.
2Shanmugasundaram S, Kambhampati SB, Saseendar S. Proximal fibular osteotomy in the treatment of medial osteoarthritis of the knee–A narrative review of literature. Knee Surg Relat Res 2019;31:1-7.
3Vaish A, Kumar Kathiriya Y, Vaishya R. A critical review of proximal fibular osteotomy for knee osteoarthritis. Arch Bone Jt Surg 2019;7:453-62.
4Agarwal DK, Saseendar S, Patro DK, Menon J. Outcomes and complications of fibular head resection. Strategies Trauma Limb Reconstr 2012;7:27-32.
5Yang 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:e1110-4.