Abstract
BACKGROUND: Proximal fibular osteotomy (PFO) and high tibial osteotomy (HTO) are two surgical options for treating varus deformities in knee osteoarthritis (KOA). While HTO provides more extensive correction, PFO offers a less invasive alternative. This study compares the radiologic and clinical outcomes of PFO and HTO to evaluate their relative efficacy. METHODS: A retrospective study was conducted with 120 patients, 60 undergoing PFO and 60 undergoing HTO, across two centers. Clinical outcomes were assessed using the Knee Society Score (KSS) and Visual Analogue Scale (VAS) for pain, while radiological outcomes were evaluated by measuring the hip-knee-ankle (HKA) angle. The complication rates were recorded, and multivariate regression analysis was performed to examine the factors influencing varus correction. RESULTS: Both groups showed significant improvements in pain and function, with no major differences in clinical outcomes between PFO and HTO (p > 0.05). However, HTO provided greater correction of the varus deformity (10.5 ± 1.5° vs. 3.1 ± 1.6°, p = 0.010). A higher proportion of PFO patients exhibited residual varus (> 3°) compared to those who underwent HTO (50% vs. 10%, p = 0.003). Complication rates were higher in the HTO group, with non-union and tibial hinge fractures occurring in 7% and 8% of patients, respectively. CONCLUSION: PFO is a less invasive option with fewer complications but provides less varus correction than HTO. Despite this, both techniques yield comparable clinical outcomes, indicating that PFO may be a viable alternative for patients with milder deformities or higher surgical risk.