Clinical Diagnosis of Common Overlapping Shoulder and Cervical Spine Disorders: A Review of Current Evidence.

¼ Pain in the shoulder is a common orthopaedic complaint that can be caused by shoulder or neck pathologies.¼ Shoulder and neck pathologies often coexist, among which one may be a predisposing factor for the other.¼ History, physical examination, and diagnostic injections can be used to discern the cause of shoulder pain and guide treatment.

Patient Perceptions of Surgeon Reimbursement in Total Ankle Arthroplasty.

INTRODUCTION: The incidence of total ankle arthroplasty (TAA) for ankle osteoarthritis has increased in the Medicare population by approximately 16.37% each year. This study examines the patient perception of orthopedic surgeon reimbursement for TAA by Medicare. METHODS: A total of 78 patients were surveyed anonymously at 2 foot and ankle clinics within an academic health care setting. The surveys were given anonymously before the patients were seen by an orthopedic surgeon. Surveys were returned to office staff who placed them in a collection box to ensure confidentiality. RESULTS: The average estimate of how much orthopedic surgeons should be reimbursed for TAA was $19 506 and the average estimate of how much orthopedic surgeons were actually reimbursed was $20 772. Fifty patients believed that orthopedic surgeons were under reimbursed, 9 believed that they were reimbursed appropriately, and 19 were unsure. Demographic variables such as age, sex, education level, income, and insurance status had no significant effect on the results. CONCLUSIONS: Most patients believed orthopedic surgeons are under reimbursed for TAA and that there is a lack of health care transparency regarding orthopedic reimbursement for TAA by Medicare.Levels of Evidence: Level V: Expert opinion.

Patient Characteristics, Length of Stay, Cost of Care, and Complications in Super-Obese Patients Undergoing Total Hip Arthroplasty: A National Database Study.

Background: The purpose of this study was to compare postoperative complication rates in super-obese (SO) patients with a body mass index (BMI) ≥ 50 kg/m2 undergoing total hip arthroplasty (THA) versus non-super-obese (NSO) patients undergoing THA. Methods: In this retrospective study using the National Inpatient Sample (NIS) database, 1,646 cases of THA in SO (BMI ≥ 50 kg/m2) patients were reviewed. We used International Classification of Diseases (ICD)-10 codes to assess postoperative variables including length of stay, cost of care (cost of inpatient hospitalization), and medical and surgical complications among SO patients undergoing THA compared to NSO patients before being discharged. Results: A comparison of demographic variables showed there were more women in both groups and nearly 17.2% of SO patients were diabetic patients, 11.1% of SO patients were tobacco users, and 74.8% of the SO patients were whites (African American, 15.1%; Hispanic, 2.9%). The mean length of stay was 3.43 days in the SO group and 2.32 days in the NSO group, and this difference was statistically significant. The cost of care was $79,784.64 for the SO group, which was significantly higher than $66,821.75 for the NSO group. The SO group also showed higher odds of developing medical complications such as anemia (odds ratio [OR], 1.555; 95% confidence interval [CI], 1.395-1.734; p < 0.001), acute renal failure (OR, 3.375; 95% CI, 2.816-4.045; p < 0.001), pneumonia (OR, 2.319; 95% CI, 1.241-4.331; p = 0.014), and need for blood transfusion (OR, 1.596; 95% CI, 1.289-1.975; p < 0.001). The SO patients also showed a higher risk of several postoperative surgical complications such as periprosthetic fractures, infection, and wound dehiscence. Conclusions: Postoperative complication rates in SO patients were higher than those in the NSO group. Length of stay and cost of care were higher, whereas the mean age was lower for the SO group. Therefore, THA in SO patients should be undertaken only after careful consideration and preferably in a tertiary facility capable of handling all medical and surgical in-hospital complications.

Analysis of inpatient complications in HIV/AIDS patients undergoing total hip arthroplasty - A propensity matched cohort study.

Patients with human immunodeficiency virus (HIV) are at higher risk for orthopedic related diseases due to dysregulation in bone metabolism and metabolic effects related to their medication regimen. Furthermore, the rate of hip arthroplasty in HIV patients is increasing. With the recent changes in THA methodologies and improvements in HIV treatment, there is a need for updated research analyzing hip arthroplasty outcomes in this high-risk patient population. In this study, we used a national database to evaluate postoperative outcomes in HIV patients undergoing THA compared to THA patients without HIV. We use a propensity algorithm to create a cohort of 493 HIV negative patients for matched analysis. Among the 367,894 THA patients included in this study, 367,390 patients were HIV negative and 504 were HIV positive. The HIV cohort had a lower mean age (53.34 vs 65.88, p < 0.001), lower proportion of females (44% vs 76.4%, p < 0.001), lower incidence of diabetes without complications (5% vs 11.1%, p < 0.001) and a lower incidence of obesity (0.544 vs 0.875, p = 0.002). In the unmatched analysis, the incidence of acute kidney injury (4.8% vs 2.5%, p = 0.004), pneumonia (1.2% vs 0.2%, p = 0.002), periprosthetic infection (3.6% vs 1%, p < 0.001), and wound dehiscence (0.6% vs 0.1%, p = 0.009) were higher in HIV cohort, most likely due to inherent demographic variances present in the HIV population. In the matched analysis, the rates of blood transfusion (5.0% vs 8.3%, p = 0.041) were lower in the HIV cohort. Other post-operative variables, such as rates of pneumonia, wound dehiscence, and surgical site infections were not statistically significant between the HIV positive population and HIV negative matched cohort. Our study found similar rates of postoperative complications in HIV positive and HIV negative patients. The rate of blood transfusions in HIV positive patients was also noted to be lower. Our data suggests that THA is a safe procedure in patients infected with HIV.

Total Knee Arthroplasty in Patients with Spinal Cord Injury: Impact on Medical Complications, Hospital Costs and Length of Stay.

INTRODUCTION: Patients with spinal cord injury (SCI) with degenerative joint disease of the knee may require total knee arthroplasty (TKA). This study examines the demographic and immediate postoperative outcomes of patients with SCI who undergo TKA. METHODS: Admissions data for TKA and SCI were analyzed from the National Inpatient Sample database using International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes. An extensive array of preoperative and postoperative variables was compared among SCI TKA patients and non-SCI TKA patients. An unmatched and matched analysis using a 1:1 propensity match algorithm was conducted to compare the two groups. RESULTS: Patients with SCI tend to be younger and have a 7.518 times greater risk of acute renal failure, 2.3 times greater risk of blood loss, and higher risk of local complications, including periprosthetic fracture and prosthetic infection. The average length of stay in the SCI cohort was 2.12 times greater, with a 1.58 times higher mean total incurred charge than the non-SCI group. CONCLUSION: SCI is associated with an increased risk of acute renal failure, blood loss anemia, periprosthetic fractures and infections, a longer length of stay, and greater incurred charges in TKA patients. STUDY DESIGN: Retrospective study.

Dialysis Patients Undergoing Total Hip Arthroplasty have Higher Rates of Morbidity and Mortality and Incur Greater Healthcare Costs: A National Database Study from 367,894 Patients.

Purpose: The incidence of a total hip arthroplasty (THA) is sevenfold higher in dialysed patients. Only a few have specifically studied the impact of chronic dialysis on outcomes of THA whilst comparing them with non-dialysed/controls. The present study questioned whether significant differences existed in morbidity and mortality rates after THA in dialysed and non-dialysed patients. Methods: The National Inpatient Sample (NIS) database Healthcare Cost and Utilization Project using records for THAs performed during 2016-2019 was employed. This largest, nationwide, in-patient database in the US acquires data from > 7 million hospital stays annually from > 20% hospitals. Among 367,894 THAs performed during 2016-2019, 383 were regularly dialysed. The two groups (dialysis and controls) were compared for in-hospital mortality, demographic data, perioperative details and medical/surgical complications. Results: Dialysed patients were younger (p < 0.001), had greater mortality (0.5% vs 0.09%, p = 0.005), lengths of stay (4.4 vs 2.3 days, p < 0.001), costs ($96,824 vs $66,848, p < 0.001) and male preponderance (p < 0.001). Postoperative dislocations (3.1% vs 1.4%, p = 0.013), mechanical complications (p = 0.032) and blood loss (p = 0.031) were greater in dialysed patients. Medical postoperative complications (myocardial infarction, pneumonia, thromboembolism, acute renal failure), periprosthetic fractures, wound dehiscence, superficial and deep surgical-site infection and periprosthetic joint infections were comparable between the 2 groups. Dialysed patients had elective THAs more often (25% vs 8.6%). Controls had higher (twofold) home discharges while ~ 50% of dialysed THAs needed discharge to another facility. Conclusions: This large national data highlighted greater morbidity and mortality among dialysis patients following THA, something to consider preoperatively along with individual circumstances whilst making risk-benefit assessments for arthroplasty. Improvements in healthcare could bridge gaps between outcomes and expectations in dialysed patients.

Cost and Early Complication Analysis Following Total Hip Arthroplasty in Parkinson's Disease Patients: A Propensity-matched Database Study.

Background: Parkinson's Disease is a well-known neuromuscular disorder, which affects the stability and gait of elderly patients. With the progressive increase in the life span of patients with PD, the problem of degenerative arthritis and the consequent need for total hip arthroplasty (THA) in this cohort are rising. There is paucity of data in the existing literature regarding the healthcare costs and overall outcome following THA in PD patients. The current study was planned to assess the hospital expenditure, details regarding hospital stay, and complication rates for patients with PD, who underwent THA. Methods: We investigated the National Inpatient Sample data to identify PD patients, who underwent hip arthroplasty from 2016 to 2019. Using propensity score, PD patients were matched 1:1 to patients without PD by age, gender, non-elective admission, tobacco use, diabetes, and obesity. Chi-square and T-tests were used for analyzing categorical and non-categorical variables, respectively (Fischer-Exact test was employed for values<5). Results: Overall, 367,890 (1927 patients with PD) THAs were performed between 2016 and 2019. Before matching, PD group had significantly greater proportion of older patients, males, and non-elective admissions for THA (P<0.001). After matching, PD group had higher total hospital costs, longer hospital stay, greater blood loss anemia, and prosthetic dislocation (P<0.001). The in-hospital mortality was similar between the two groups. Conclusion: Patients with PD undergoing THA required greater proportion of emergent hospital admissions. Based on our study, the diagnosis of PD showed significant association with greater cost of care, longer hospital stay, and higher post-operative complications.

How does systemic lupus erythematosus impact the peri-operative complication rates in primary hip arthroplasty? A national inpatient sample-based study.

INTRODUCTION: With prolonged life expectancy, the number of patients with systemic lupus erythematosus (SLE) undergoing total hip arthroplasty (THA) has substantially increased over the past years. The post-operative outcome and complications in SLE are less clearly understood than other inflammatory diseases, due to limited availability of evidence within the literature. METHODS: Using the National Inpatient Sample (NIS) database, patients who underwent THA between 2016 and 2019 were identified (ICD-10 CMP code). Patients were then classified into one of the two groups, namely those with SLE (ICD-10-CM; code710.0) or those without SLE (NSLE). Data regarding demographic details, co-morbidities, details regarding hospital stay, expenditure incurred, and complications encountered were analyzed, and compared between the groups. RESULTS: Overall, among 367,894 patients undergoing THA, 1684 (0.5%) had SLE. Mean age of SLE (57.3 ± 14.5 years) patients undergoing THA was significantly lower than NSLE (65.9 ± 11.4 years) population (p = 0.001). There was a greater proportion of female patients in SLE group [89.6% (SLE) vs 55.8% (NSLE); p = 0.001]. SLE patients had a greater incidence of emergent hospital admissions (p = 0.04), longer hospital stay (p = 0.001), and higher hospital-related expenditure (p = 0.001). Among the peri-operative complications, SLE patients had significantly greater risk of developing post-operative anemia (p = 0.001), need for blood transfusion (p = 0.001), peri-prosthetic mechanical complications (p = 0.04), and prosthetic dislocations (p = 0.001). There was also a greater incidence of peri-prosthetic infections in the SLE group (p = 0.001). CONCLUSION: The presence of SLE significantly lengthens hospital stay and augments healthcare-related costs in patients undergoing THA. The three main complications which may significantly affect the post-operative course of these patients include higher rates of post-operative anemia, peri-prosthetic infections, and early prosthetic dislocations.

Does systemic lupus erythematosus impact the peri-operative complication rates following primary total knee arthroplasty? A national inpatient sample-based large-scale study.

INTRODUCTION: Consequent to improved life expectancies, there has been a substantial increase in the proportion of patients with systemic lupus erythematosus (SLE) undergoing total knee arthroplasty (TKA) over the past 2 decades. In comparison to the other inflammatory disorders, the complication rates and post-operative outcome in patients with SLE are less clearly understood, owing to the paucity of evidence in the literature. METHODS: Patients who underwent TKA between 2016 and 2019 were identified (ICD-10CMP code) using the National Inpatient Sample (NIS) database and then classified into one of the two groups, namely those with SLE (ICD-10-CM; code710.0) and those without SLE (NSLE). Demographic details, co-morbidities, details regarding hospital stay, costs incurred, and complications encountered of this patient cohort were analysed and compared between the two groups. RESULTS: Overall, among 5,58,361 patients undergoing TKA, 2,094 (0.38%) patients had SLE. The SLE group was significantly younger than NSLE population (62.2 ± 9.9 vs 66.7 ± 9.5 years; p < 0.001). The proportion of female and African-American patients was higher in the SLE group (p < 0.001). SLE patients had a significantly longer hospital stay (p < 0.001) and greater hospital-related expenditure (p < 0.001). Among the peri-operative complications, SLE patients had significantly greater risk of developing post-operative anemia (19.2% in SLE vs 15.3% in NSLE; p < 0.001), requiring blood transfusion (2.8% in SLE vs 1.5% in NSLE; p < 0.001), and acquiring peri-prosthetic joint infections (1.9% in SLE vs 1% in NSLE; p < 0.001). CONCLUSION: The presence of SLE significantly lengthens hospital stay, and augments the health-care-related costs in patients undergoing TKA. The rates of peri-prosthetic infections, post-operative anemia, and need for blood transfusions are significantly greater in SLE patients.

Cost and Complications in Rheumatoid Arthritis Patients Undergoing Primary Hip Arthroplasty: A National Inpatient Sample-Based Study.

INTRODUCTION: Rheumatoid arthritis (RA) is an autoimmune disease that affects multiple synovial joints in the body, including the hip. Hip involvement in RA patients is fairly common, but the current literature is lacking large-scale studies on the surgical outcomes of RA patients undergoing total hip arthroplasty (THA). The aim of the study is to examine the outcomes and hospital costs associated with THA in patients with RA and compare them to patients without RA using the National Inpatient Sample (NIS) database. METHODS: We analyzed the NIS database to identify patients undergoing THA between 2016 and 2019 using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. Multiple variables including demographics, medical comorbidities, total hospital costs, length of stay, and perioperative complication rates were then compared between patients with and without RA. Further, the two groups were matched for demographic differences, if any, using a 1:1 propensity match algorithm. RESULTS: Patients with RA undergoing THA were significantly younger and predominantly female when compared to patients without RA. There was also a lower incidence of obesity and the percentage of elective THA procedures were smaller in the RA group. The RA group had a longer length of stay and increased incidences of blood loss anemia, blood transfusion, and periprosthetic fractures. These differences persisted despite matching the two groups for demographic differences, elective procedures, diabetes, obesity, and tobacco usage. CONCLUSION: THA in RA is associated with an increased incidence of blood loss anemia, blood transfusion, and periprosthetic fractures, as well as a longer length of stay in THA patients.

Complications, demographics and hospital stay in organ transplant patients undergoing total hip arthroplasty - A national database study between 2016 and 2019.

Background: The purpose of this study was to analyze the post-operative complications following THA in organ transplant patients; and compare the outcome with general population undergoing THA. Methods and materials: In this retrospective study using the National Inpatient Sample (NIS) database, 813 cases of THA (both primary and revision THA) in organ transplant patients (OT) were reviewed. ICD-10 codes were used to assess post-operative variables including the length of stay, cost of care, medical and surgical complications among OT patients undergoing THA. A comparison of all these variables was made with the non-OT (NOT) control population. Results: Among 367,894 patients undergoing THR between 2016 and 2019 on NIS database, 813 were OT patients. There was significantly greater proportion of males in the OT group (p < 0.001). Patients in the OT group were also significantly younger (mean age: 61.08 ± 11.95 in OT versus 65.87 ± 11.39 years in NOT; p < 0.001). The OT group had significantly higher prevalence of anemia (p < 0.001), acute renal failure (ARF; p < 0.001), and transfusion rates (p < 0.001). The OT patients also had significantly greater dislocation rates (p = 0.010), wound dehiscence (p = 0.03) and deep surgical-site infections (SSI; p = 0.002). The mean length of hospital stay (3.55 ± 4.89 days in OT vs 2.32 ± 2.52 days in NOT; p < 0.001), cost of care ($82,567.89 ± 74,505.54 vs $66,845.18 ± 47,761.39 for OT and NOT groups, respectively; p < 0.001) and mortality (p = 0.04) were significantly greater in the OT population, as compared to controls. Conclusion: Organ transplant patients have significantly greater risk for developing post-operative complications like anemia, ARF, need for higher transfusion rates, prosthetic dislocations, wound dehiscence, and deep SSI following THA. The length of stay, total expenditure incurred and mortality were also higher in OT patients undergoing THA.

Complications During the Hospital Stay, Length of Stay, and Cost of Care in Parkinson Patients Undergoing Total Knee Arthroplasty: A Propensity Matched Database Study.

BACKGROUND: Patients with Parkinson disease (PD) undergoing total knee arthroplasty (TKA) can present with a unique subset of challenges during their hospital stay. The literature is limited to single-center studies with a small number of patients. This study was aimed to analyze the inpatient complications, length of stay (LOS), and cost of care (COC) associated after TKA with PD over 4 years (2016 to 2019). METHODS: In this retrospective cohort study, we used National Inpatient Sample (NIS) database data from 2016 to 2019 and compared in-hospital complications, LOS, and COC among patients undergoing TKA with and without PD. RESULTS: The National Inpatient Sample database is used to identify 558,371 patients (555,289 without PD and 3,082 with PD) who underwent TKA. After propensity-matching, there was an increased incidence of blood loss anemia (PD group 22.3%, control group 13.5%, P ≤ 0.01), periprosthetic dislocations (1.5% in PD group, 0.4% in control group, P < 0.001), and periprosthetic mechanical complications including but not limited to periprosthetic fractures, knee dislocations, patellar maltracking, and subluxations (1.1% in PD group, 0.6% in control group, P = 0.024) in the PD group. The other in-hospital complications including mortality, acute renal failure, myocardial infarction, pneumonia, pulmonary embolism, deep vein thrombosis, periprosthetic fracture, and wound dehiscence showed no notable differences. The average total incurred charges for the PD group were higher, with a mean of $67,581.58 (SD $44,554.64), than that in the control group, with a mean of $64,795.51 (SD $45,841.25) (P < 0.001). The average LOS was higher in the PD group with a mean of 2.7 days (SD = 1.93) compared with the control group (mean = 2.3, SD = 1.73 days, P < 0.001). CONCLUSIONS: An increased incidence of complications such as acute blood loss anemia, periprosthetic mechanical complications, and increased COC, but no difference in LOS was noted in patients undergoing TKA with PD. This information can be useful to make an informed decision regarding patient care and preferred healthcare setup for TKA in patients with PD.

Retrograde Intramedullary Nailing and Locked Plating for the Treatment of Periprosthetic Supracondylar Femur Fractures: A Meta-Analysis and Quantitative Review.

Background: As the prevalence of Total Knee Arthroplasty increases, there is still debate over the preferred method of treatment of supracondylar periprosthetic femoral fractures. The aim of this study was to compare two of the common methods of fixation: Locked Plating and Retrograde Intramedullary Nailing with respect to nonunion, delayed union and surgical revision rate. Methods: A comprehensive database search via Pubmed was conducted, yielding 16 eligible studies. Six of those studies were comparative and were used in the meta-analysis section. All 16 studies were used in the pooled sample analysis section. The primary outcome analyzed was nonunion and delayed union rate while the secondary outcome was the surgical revision rate. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated by comparing incidences of nonunion and delayed union, and surgical revision rates among the studies. Results: The meta-analysis showed that there is no statistically significant difference among the two groups in terms of nonunion and delayed union rate (OR = 1.43, CI = 0.74, 2.74, P=0.28), but there is a significant difference in the surgical revision rate favoring locked plating over retrograde intramedullary nailing (OR = 2.71, CI = 1.42, 5.17, P=0.003). The pooled sample analysis showed that there is no significant difference in the nonunion and delayed union rates (P=0.210) or the surgical revision rates (P=0.038). Conclusion: Both locked plating and Retrograde Intramedullary Nailing are reliable options for treating supracondylar femoral fractures around Total Knee Arthroplasty. Locked plating demonstrated a trend towards decreased nonunion and delayed union rates and a significantly lower surgical revision rate in the meta-analysis.

HIV/AIDS patients undergoing total knee arthroplasty are at higher risk of acute renal failure and transfusion and incurred higher cost: a propensity-matched database study.

INTRODUCTION: Human immunodeficiency virus (HIV) is a retrovirus that can cause acquired immunodeficiency syndrome (AIDS). Total knee arthroplasty (TKA) in HIV-positive patients has not been well documented in the current literature. Thus, this study aimed to examine the early postoperative outcomes and complications of HIV-positive TKA patients as compared to TKA patients who are HIV-negative patients by utilizing the National Inpatient Sample (NIS) database. METHODS: Admissions data for TKA and HIV were analyzed from the NIS database using ICD-10-CM diagnosis codes. An extensive array of preoperative and postoperative variables was compared among HIV positive TKA patients and HIV negative TKA patients. An unmatched analysis and a matched analysis using a 1:1 propensity match algorithm were conducted to compare the two groups. RESULTS: The average age of the HIV-positive group was lower than the HIV-negative group (59.0 vs 66.7, p < 0.001). The HIV-positive group had a smaller percentage of females (38.4% vs 61.5%, p < 0.001) and a lower incidence of tobacco-related disorders than the HIV-negative group (10.3% vs 15.8%, p = 0.032). The HIV-positive group had a longer mean length of stay (3.0 days vs 2.4 days, p < 0.001) and a greater mean total charge incurred (90,780.25 vs 64,801.55, p < 0.001). In the unmatched analysis, the incidence of acute renal failure (6.4% vs 2%, p < 0.001), transfusions (3.9% vs 1.5%, p = 0.004), and periprosthetic joint infection (3% vs 1%, p = 0.007) was higher in HIV positive group. The matched analysis showed a higher incidence of acute renal failure group (6.4% vs 0.5%, p = 0.01) and transfusions (3.9% vs 5%, p = 0.01) in the HIV-positive but a statistically insignificant difference in the rate of periprosthetic joint infection (3% vs 1%, p = 0.153). CONCLUSION: HIV/AIDS is associated with an increased incidence of acute renal failure and transfusions, as well as a longer length of stay and higher incurred costs in TKA patients.

Proximal fibular osteotomy: Systematic review on its outcomes.

BACKGROUND: The morbidity and burden of knee osteoarthritis affecting millions of lives worldwide has created a constant pursuit in finding the ideal treatment for knee osteoarthritis. There has been a paradigm shift in the surgical treatment of osteoarthritis ever since the initial description of Volkmann's tibial osteotomy. This review focuses on one such recent procedure, the proximal fibular osteotomy (PFO) for medial compartment knee osteoarthritis. This review encompasses the history, evidence, risk factors, outcomes and technical considerations of PFO. AIM: To understand the evidence and its techniques, and whether this could be an alternative solution to the problem of knee osteoarthritis in the developing world. METHODS: The phrases "proximal fibular osteotomy" and "knee osteoarthritis" were searched (date of search December 20, 2019) on PubMed to identify articles evaluating the biomechanical and clinical outcomes of PFO in patients with knee osteoarthritis. A total of 258 were retrieved. After reviewing the summary of the texts, 22 articles written in English were marked for abstract review. Articles that were case studies or cadaver experiments were excluded. The abstracts of the remaining articles were read, and only those that focused on the history, outcomes of case studies and technical considerations of PFO were included in the review. A total of 12 articles were included in this review. RESULTS: At least six studies reported improvement in the visual analogue scale(VAS) from the average preoperative VAS score [6.32, 95% confidence interval (CI) = (4.05, 8.59)] to average postoperative VAS score [1.23, 95%CI: (-1.20, 3.71)], which was statistically significant. Similarly, the American Knee Society Score (KSS) functional score improved from an average preoperative KSS functional score [43.11, 95%CI: (37.83, 48.38)] to postoperative KSS functional score [66.145, 95%CI: (61.94, 70.35)], which was statistically significant. The femorotibial angle improved by around 7º, and the hip knee ankle angle improved by around 6º. CONCLUSION: With the existing data, it seems that PFO is a viable option for treating medial joint osteoarthritis in selected patients. Long term outcome studies and progression of disease pathology are some of the important parameters that need to be addressed by use of multicenter randomized controlled trials.