Surgical factors that contribute to tibial periprosthetic fracture after cementless Oxford Unicompartmental Knee Replacement: a finite element analysis

In small patients with marked tibia vara the surgery is unforgiving. To avoid fracture, the horizontal cut should be conservative, aiming for a 3 bearing, the vertical cut should abut the apex of the medial tibial spine, and extreme internal or external rotation should be avoided. The component should be aligned with the posterior cortex and should not overhang anteriorly. In addition, contrary to current recommendations, the tibial component should be placed in varus (about 5°).