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Usefulness of Fluoroscopy for Extramedullary Tibial Bone Cutting and Arthroscopy for Excess Cement Removal in Medial Unicompartmental Knee Arthroplasty

March 01, 2019

Contributors: Sukho Baek; Kwang-Jin Chun; Dong-Hyun Kim; Dong-Hoon Lee; Jae Sung Lee, M.D,PhD; Hyeongjun Park; Yong-Beom Park, MD; Beoung-Il Yun Sr, MD; Han-Jun Lee, MD; Han-Jun Lee, MD

The success of unicompartmental knee arthroplasty depends on appropriate patient selection and proficient surgical technique. This video describes the results of fluoroscopy for tibial component positioning and arthroscopy for extruded cement removal in medial unicompartmental knee arthroplasty. This retrospective study included 85 consecutive patients who underwent medial unicompartmental knee arthroplasty with the use of fluoroscopy and arthroscopy. Fluoroscopy was used at the time of proximal tibial cutting with an extramedullary guide, comparing preliminary construction on radiographs with fluoroscopic imaging. In addition, dry arthroscopy was used preoperatively for inspection of all compartments of the joint and after final implantation for removal of excess cement in the posterior aspect. Clinical outcomes were evaluated based on range of motion, Knee Society Knee score, Knee Society Function score, and Western Ontario and McMaster Universities Osteoarthritis Index score. Coronal component alignment was determined using radiographs. Range of motion improved from 122.4° preoperatively to 140.6° at final follow up. Substantially improved Knee Society Knee scores, Knee Society Function scores, and Western Ontario and McMaster Universities Osteoarthritis Index scores were reported at final follow up. The hip-knee-ankle angle improved from 175.4° preoperatively to 177° at final follow up. Coronal orientation of the femoral prosthesis was 90.04°, and sagittal orientation of the femoral prosthesis was 88.68°. Coronal orientation of the tibial prosthesis was 89.58°, and sagittal orientation of the tibial prosthesis was 88.78°. With regard to postoperative mechanical limb alignment, no outliers were present in all radiographic parameters (<±3° from targeted values). No extruded cement remained on the posteromedial aspect. The results of this study suggest that arthroscopy and fluoroscopy are useful modalities for prosthesis alignment and extruded cement removal in unicompartmental knee arthroplasty.

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