Vol. 7, Issue 2, Part B (2025)

Background: High tibial osteotomy (HTO) is a standard procedure for treating unicompartmental knee osteoarthritis with varus malalignment. Lateral closing wedge hybrid HTO requires managing the fibula for proper tibial correction. This study compares the outcomes of two distinct techniques- segmental fibular excision and oblique osteotomy, focusing on nonunion at the fibular osteotomy site and peroneal nerve palsy.

Methods: A retrospective study of 85 patients who underwent lateral closing wedge hybrid HTO. Patients were divided into fibular excision (n=53) and fibular oblique osteotomy (n=32) groups and were followed up for 2 years. Clinical outcomes included union rates, nonunion, delayed union, revisions, and peroneal nerve palsy incidence. PROMs like Oxford Knee Score(OKS), WOMAC Score, Knee Society Score(KSS) and Knee Society Score-Function(KSSF) with treatment were evaluated. Radiological assessment included Pre and post-operative FTA angle, and presence or absence of non-union at the fibular site. Chi-square tests were used for statistical analysis.

Results: At a minimum 2- year follow up, there were no statistically significant differences in the mean FTA, KSS and KSSF scores of both the groups. Union rates were 30% (n=16) in fibula excision and 71% (n=23) in oblique osteotomy group. Nonunion was 66% (n=35) in excision and 18% (n=6) in oblique (p<0.001). Only 2 patients out of 41 non-union (4.87%) had pain at fibular site and required revision. Peroneal nerve palsy occurred in 15 patients (18.8%; 8 in excision [15%], 7 in oblique [21%]; (p>0.05) with no statistical significant difference.

Conclusion: Fibular oblique osteotomy yields comparatively higher union rate than fibular excision. No significant difference in peroneal nerve palsy incidences between the two techniques.