Abstract: OBJECTIVE: Proximal fibular osteotomy and high tibial osteotomy are both effective approaches to treat knee osteoarthritis by presenting different advantages, but the choice of the two surgical approaches is still controversial in clinical practice. This article systematically evaluated the safety and effectiveness of proximal fibular osteotomy compared with high tibial osteotomy for treatment of knee osteoarthritis.
METHODS: The databases including PubMed, Cochrane Library, Web of Science, CNKI, VIP and Wanfang were searched by computer for clinical studies on proximal fibular osteotomy versus high tibial osteotomy in the treatment of knee osteoarthritis. After screening of literature, the data extraction, and the evaluation of the quality of the literature were conducted. The modified the Jadad Scale was used to evaluate the quality of randomized controlled trials. The Newcastle-Ottawa quality evaluation Scale was used to evaluate the quality of cohort studies. RevMan 5.3 software was applied into the research outcome data statistical analysis. For indicators with significant heterogeneity, the heterogeneity was reduced by excluding some literatures deviating from the forest plot, and then combined analysis was carried out. Simultaneously, funnel plot was also drawn to analyze the publication bias of the included studies. 
RESULTS: (1) Totally 13 articles were included, including 12 in Chinese and 1 in English, with a total of 878 patients. (2) The literature quality evaluation showed that among the nine randomized controlled trials, four articles were of high quality and five articles were of low quality, and among the four retrospective cohort studies, three articles were of high quality and one article was of low quality. (3) Meta-analysis results showed that visual analogue scale scores at 3 months (MD=0.07, 95%CI: -0.05-0.20, P=0.25), visual analogue scale scores at 6 months (MD=0.03, 95%CI:-0.16-0.21, P=0.78) after surgery, HSS scores at 3 months (MD=-1.08, 95%CI: -2.41-0.25, P=0.11) and HSS scores at 6 months (MD=-0.68, 95%CI:-1.80-0.45, P=0.24) after surgery showed no significant differences. However, compared with the high tibial osteotomy group, the mean operative time (MD=-36.76, 95%CI:-38.20 to -35.33, P < 0.000 01), intraoperative blood loss (MD=-2.10, 95%CI:-2.35 to -1.84, P < 0.000 01) and hospital stay (MD=-4.31, 95%CI:-4.63 to -3.98, P < 0.000 01) of the proximal fibular osteotomy group were significantly less, and the incidence of postoperative complications was lower (OR=0.46, 95%CI:0.22-0.97, P=0.04).
CONCLUSION: Proximal fibular osteotomy has the same short-term efficacy as high tibial osteotomy in the treatment of knee osteoarthritis, but proximal fibular osteotomy can reduce the operation time, intraoperative blood loss and postoperative complications. Clinically, proximal fibular osteotomy is preferred for patients with many complications and poor operation tolerance. However, due to the limited quality and follow-up time of the included studies, more high-quality clinical studies with multi centers, large samples and long follow-up time are needed for verification.

Key words: bone, knee, osteoarthritis, fibula, tibia, tibial plateau, osteotomy, systematic review, meta-analysis