Proximal partial fibular resection versus high tibial osteotomy: Comparative outcomes in early-stage knee osteoarthritis

Objectives: This study aims to compare the clinical and radiographic outcomes of proximal partial fibular resection (PPFR) and opening-wedge high tibial osteotomy (OWHTO) in middle-aged patients with early-stage medial compartment knee osteoarthritis (OA). Patients and methods: Between January 2017 and January 2023, a total of 90 patients (47 males, 43 females; mean age: 50.9 +/- 5.8 years; range, 40 to 59 years) who underwent PPFR or OWHTO for early-stage medial compartment knee OA were retrospectively analyzed. The patients were divided into two groups based on the surgical technique: Group 1 (n=48) included those who underwent PPFR, while Group 2 (n=42) comprised those treated with OWHTO. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic measurements included femorotibial angle (FTA) and lateral joint space (LJS). Results: Both procedures demonstrated a significantimprovement in function and pain. The mean postoperative FTA change was greater in the OWHTO group (7.69 +/- 1.35 degrees) compared to the PPFR group (2.87 +/- 1.24 degrees, p=0.001). The mean LJS changes were not statistically significant between the groups. Postoperative WOMAC and VAS scores improved in both groups, indicating no significant difference. Minor complications included transient peroneal nerve symptoms in the PPFR group, which resolved spontaneously at three months postoperatively. Conclusion: Both PPFR and OWHTO are effective surgical options for early-stage medial compartment knee OA. While OWHTO offers superior mechanical correction, PPFR provides a less invasive alternative with similar functional outcomes.