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Joint Diseases and
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Original Article · Open access

In case effects of proximal fibular osteotomy and total knee arthroplasty on load distribution in the human knee: A comparative finite element study

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Bünyamin Ari

Department of Orthopedics and Traumatology, Kütahya Health Sciences University Faculty of Medicine, Kütahya, Türkiye

ORCID: 0000-0001-7638-7932

Melih Canlidinç

Department of Mechanical Engineering, Dumlupınar University Faculty of Engineering, Kütahya, Türkiye

ORCID: 0000-0002-4011-9490

Nafiz Yaşar

Department of Mechanical Engineering, Dumlupınar University Faculty of Engineering, Kütahya, Türkiye

ORCID: 0000-0002-1427-1384

Mehmet Ali Gedik

Department of Radiology, Kütahya Health Sciences University Faculty of Medicine, Kütahya, Türkiye

ORCID: 0000-0002-1548-0444

Abstract

Objectives: This study aims to quantitatively compare the biomechanical effects of proximal fibular osteotomy (PFO), total knee arthroplasty (TKA), and combined TKA+PFO on load distribution in the human knee under physiological axial loading.

Materials and methods: Four finite element models were constructed from high resolution computer-aided design (CAD) geometries: intact knee, PFO, TKA (cobalt chromium femoral/tibial components with polyethylene insert), and TKA+PFO. Linear elastic, isotropic material properties were assigned to bone, menisci, and implant components. Each model was meshed with 10 node tetrahedral elements (1-mm element size) in ANSYS workbench 2022 R2. A static axial load of 750 N was applied to the femur; distal tibia and fibula surfaces were fully constrained. Total deformation and von Mises stress were extracted for anterior (A), posterior (P), medial (M), lateral (L), and global maximum (Max) regions, and percentage deviations (Δ) were computed relative to the intact model.

Results: The PFO increased regional deformations by 68 to 74% and redistributed stress posteriorly (+104% in P), with modest stress reductions anteriorly (–11%) and medially (–17%). TKA alone increased deformations by 39 to 46%, while reducing stress by >95% anteriorly, medially, and posteriorly, and ~65% laterally. Both TKA+PFO produced the greatest compliance increase (Δ>114%) and deepest stress off loading (global Δ ≈–84%). The combined approach synergistically minimized peak stresses (~5.6 MPa) at the expense of maximal deformation (~6.0 mm).

Conclusion: Our study results suggest that PFO and TKA exert distinct biomechanical modifications and their combination offers more satisfactory stress reduction, but markedly increases compliance. We believe that these findings can be used to tailor surgical planning and implant design and to optimize joint mechanics.

Declarations

Author Contributions

Responsible for the organization and coordination of the study: B.A.; Analysis of samples: B.A., M.A.G.; Biomechanical tests: M.C., N.Y.; Data analysis and literature comparison: B.A., M.C., N.Y., M.A.G.; Author of the article: B.A.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Gultac E, Can Fİ, Hürriyet Aydoğan N. Proximal partial fibular resection versus high tibial osteotomy: Comparative outcomes in early-stage knee osteoarthritis. Jt Dis Relat Surg 2025;36:266-71. DOI: 10.52312/jdrs.2025.2107.
  2. Yan F, Zhao X, Duan S, Maimaiti A, Qi Y, Li M, et al. High fibular osteotomy ameliorates medial compartment knee osteoarthritis in a rabbit model. J Biomech 2021;128:110734. DOI: 10.1016/j.jbiomech.2021.110734.
  3. Agrawal NK, Vaishya SS. Proximal fibular osteotomy: A novel technique for management of medial compartment knee osteoarthritis. Ann Int Med Den Res 2019;5:OR01OR03.
  4. Vashisht A, Menwal G, Bhatnagar R. A clinicoradiological evaluation of functional outcome of proximal fibular osteotomy for medial compartment knee osteoarthritis: a new emerging technique. Int J Res Orthop 2020;6:515-20.
  5. Sun Q, Zhang K, Yang D, Liu Y, Xu Y, Zheng S. Proximal fibular osteotomy definitively ameliorates medial compartment knee osteoarthritis: A finite element analysis. J Orthop 2025;69:47-52. DOI: 10.1016/j.jor.2025.03.005.
  6. Sugianto JA, Hadipranata T, Lazarus G, Amrullah AH. Proximal fibular osteotomy for the management of medial compartment knee osteoarthritis: A systematic review and meta-analysis. Knee 2021;28:169-85. DOI: 10.1016/j.knee.2020.11.020.
  7. Sabir AB, Faizan M, Singh V, Jilani LZ, Ahmed S, Shaan ZH. Proximal fibular osteotomy: Is it really an option for medial compartmental osteoarthritis knee? Our experience at tertiary centre. Indian J Orthop 2020;55:228-33. DOI: 10.1007/s43465-020-00289-y.
  8. Qin D, Chen W, Wang J, Lv H, Ma W, Dong T, et al. Mechanism and influencing factors of proximal fibular osteotomy for treatment of medial compartment knee osteoarthritis: A prospective study. J Int Med Res 2018;46:3114-23. DOI: 10.1177/0300060518772715.
  9. Gavrilovski A, Dimovska AG, Spasov M, Kostov H, Igor IM, Jonoski K, et al. Alternative treatment of gonarthrosis: Proximal fibular osteotomy. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2024;45:13-8. DOI: 10.2478/prilozi-2024-0002.
  10. Unal OK, Dagtas MZ, Demir C, Najafov T, Ugutmen E. The effects of proximal fibular osteotomy on the knee and ankle joints: A finite element analysis. Acta Chir Orthop Traumatol Cech 2021;88:313-20.
  11. Ashraf M, Purudappa PP, Sakthivelnathan V, Sambandam S, Mounsamy V. Proximal fibular osteotomy: Systematic review on its outcomes. World J Orthop 2020;11:499-506. DOI: 10.5312/wjo.v11.i11.499.
  12. Pan D, TianYe L, Peng Y, JingLi X, HongZhu L, HeRan Z, et al. Effects of proximal fibular osteotomy on stress changes in mild knee osteoarthritis with varus deformity: A finite element analysis. J Orthop Surg Res 2020;15:375. DOI: 10.1186/s13018-020-01894-1.
  13. Liu B, Chen W, Zhang Q, Yan X, Zhang F, Dong T, et al. Proximal fibular osteotomy to treat medial compartment knee osteoarthritis: Preoperational factors for short-term prognosis. PLoS One 2018;13:e0197980. DOI: 10.1371/journal.pone.0197980.
  14. Kumar S, Srivastava S, Kumar S, Verma V. Proximal fibular osteotomy for medial joint osteoarthritis of the knee: A prospective cohort study. Cureus 2021;13:e19180. DOI: 10.7759/cureus.19180.
  15. Khalil TM, Nassar WAM, Sakr HM, Zakaria ZM, El Seddawy AM, Morsy AMM. Proximal fibular osteotomy versus medial opening wedge high tibial osteotomy to treat medial compartment knee osteoarthritis: A randomized clinical trial. Ain Shams Med J 2021;72;217-26.
  16. Kang Y, Kim J, Sim JA, Moon M, Park JC, Cho SH, et al. Stress effect in the knee joint based on the fibular osteotomy level and varus deformity: A finite element analysis study. Bioengineering (Basel) 2023;10:1003. DOI: 10.3390/bioengineering10091003.