Proximal partial fibular resection instead of total knee prosthesis in a patient with metal allergy

Abstract

Knee osteoarthritis is a common joint disease affecting middle-aged and elderly individuals.[1] High tibial osteotomy (HTO), unicompartmental or total knee arthroplasty (TKA) can be preferred as surgical treatment modalities in patients with medial compartment arthrosis. These methods are usually determined according to the age of the patient, the degree of medial arthrosis, the presence of arthrosis in the lateral compartment, and the experience of the surgeon. All of these surgical treatment options require metallic biomaterials such as stainless steels, titanium alloys, and cobalt-chromium alloys. According to the patch test and blood analysis, the frequency of nickel, cobalt, chromium skin allergies in the general population is 13%, 2% and 1%, respectively. Although metal hypersensitivity is estimated between 10 to 15% in the general population, even higher incidences may be observed up to 25%.[2] A 66-year-old female patient with Grade III osteoarthritis was considered for primary total knee arthroplasty (TKA). Due to her metal allergy, TKA was abandoned and proximal partial fibular resection (PPFR) was planned. The patient was evaluated at regular follow-ups. Based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analog Scale (VAS) scores, a significant improvement, particularly in terms of pain and functional scores with limited radiological change, was observed. In conclusion, the PPFR is a viable surgical treatment option in patients with gonarthrosis who have metal hypersensitivity.