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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims Unicompartmental arthroplasty provides an alternative to total knee arthroplasty (TKA) for end-stage osteoarthritis (OA) affecting a single knee compartment, typically the medial compartment, and less commonly the lateral compartment. Patients undergo orthopaedic assessment for surgical suitability based on examination and X-ray findings of unicompartmental OA before surgical consideration. Sometimes, due to inconclusive X-ray findings or a long waiting time between initial X-ray findings and booking for surgery, the patient‘s knee OA can progress, and surgeons may opt for intraoperative conversion to TKA based on direct knee cartilage assessment. Can ultrasound effectively assess both knee compartments to confirm the diagnosis?
Methods In this retrospective review of 35 patients scheduled for medial compartment knee arthroplasty, an ultrasound examination of the medial and lateral compartments and the posterior knee was conducted during genicular nerve and IPACK blocks. Findings in patients with advanced medial compartment arthritis (Image 1): 1.Bulging of the medial collateral ligament, 2.Bulging of the medial meniscus, 3.Osteophyte formation, 3-joint space narrowing, 4.Occasional joint effusions and Baker’s cysts.
Results Similar ultrasound findings were observed in 7 out of 35 patients within the lateral compartment. These results were communicated to the surgeon. These findings were confirmed intraoperatively by direct assessment of the joint by the surgeon, ultimately leading to conversion to TKA for all eight patients.
Conclusions In this retrospective review, point-of-care ultrasound was performed after spinal anaesthesia. A pre-anaesthetic ultrasound examination of the knee by the anaesthetist may confirm the diagnosis and allow adjustment of spinal anaesthesia dosage to accommodate surgical timing for unicompartmental versus TKA.