T. Otani et al., IMPINGEMENT AFTER TOTAL KNEE ARTHROPLASTY CAUSED BY CEMENT EXTRUSION AND PROXIMAL TIBIOFIBULAR INSTABILITY, The Journal of arthroplasty, 13(5), 1998, pp. 589-591
A 57-year-old patient with rheumatoid arthritis showed posterolateral
impingement after total knee arthroplasty. The radiographs showed bone
cement extrusion posterolateral to the tibial tray. Arthrotomy throug
h a posterolateral approach revealed that the impingement was caused n
ot only by cement extrusion against the fibular head bur also by proxi
mal tibiofibular joint instability. It was speculated that rheumatoid
arthritis had caused proximal tibiofibular instability, active knee mo
tion had caused fibular head shift by tension of biceps femoris and th
e fibular head had been impinged on the extruded cement. In cementing
the tibial tray, especially in a rheumatoid patient, it is of paramoun
t importance to take caution against posterolateral cement extrusion i
n order to minimize the risk of fibular head impingement during total
knee arthroplasty.