Abstract
BACKGROUND: This study comprehensively and methodically assessed the effectiveness of proximal fibular osteotomy (PFO) compared to unicompartmental knee arthroplasty (UKA) as treatment for medial compartment knee osteoarthritis (KOA) to offer direction and evidence to support clinical surgical decision-making. METHODS: Literature screening was strictly conducted according to the inclusion criteria, and reasonable outcome indicators were selected from the included studies. The PubMed, Web of Science, Wanfang Data, CQVIP, and CNKI databases were searched using a predefined search strategy. Quality assessment was stratified by study design: the Cochrane Risk of Bias 2.0 tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for non-RCTs. After extracting relevant data from the included studies, a meta-analysis was performed using RevMan 5.4 software. RESULTS: Thirteen studies involving 698 patients were included, with 355 and 343 patients in the PFO and UKA groups, respectively. The meta-analysis revealed that the PFO group had a shorter surgical duration, less intraoperative blood loss, shorter hospital stay, and lower hospitalization costs than the UKA group. Nevertheless, no statistically significant differences in the postoperative visual analog scale scores (VAS), Hospital for Special Surgery (HSS) scores, knee range of motion (ROM), Knee Society Score (KSS), femorotibial angle, and incidence of postoperative complications were observed between the PFO and UKA groups. CONCLUSIONS: PFO and UKA provide comparable short-term functional outcomes for medial compartment KOA, with PFO offering advantages in surgical efficiency and cost. However, given the high heterogeneity and limited long-term data, these findings should be interpreted cautiously, and further high-quality studies are needed to confirm the durability and broader applicability of PFO.