Proximal Fibular Osteotomy Versus Hyaluronic Acid Injections for Medial Compartment Knee Osteoarthritis: An Innovative Descriptive Study with Five-Year Follow-Up

Background: Medial compartment knee Osteoarthritis (OA) presents a significant treatment challenge, particularly for patients unwilling to undergo Total Knee Arthroplasty (TKA). This study compared the clinical outcomes of Proximal Fibular Osteotomy (PFO) and Hyaluronic Acid (HA) injections in patients with grade III-IV medial compartment OA. Methods: From 2018 to 2019, 47 patients with grade III-IV medial compartment knee OA and no flexion contracture were enrolled and followed for five years. All were deemed candidates for TKA but declined surgery. Group A (n=22) received intra-articular HA injections; Group B (n=25) underwent PFO. The Knee Society Score (KSS) and Visual Analog Scale (VAS) for pain were assessed at baseline and at 3, 6 and 12 months, then annually for 5 years. Patients with flexion contracture were excluded due to the limited efficacy of non-arthroplasty interventions in such cases. Results: At one year, both groups showed improvement, but outcomes were significantly better in the PFO group (KSS 78.9 vs. 59.3; VAS 3.1 vs. 5.8). Over five years, 100% of HA-treated patients progressed to TKA, while only 5 of 25 in the PFO group required surgery. One transient peroneal nerve palsy was observed in the PFO group, with full recovery in four weeks. Conclusion: Proximal Fibular Osteotomy offers a promising, low-cost alternative for managing medial compartment OA in select patients. Compared to HA injections, PFO provided superior long-term symptom relief and significantly reduced the need for knee arthroplasty.