106 patients (107 knees), who were scheduled to undergo primary conventional unilateral total knee arthroplasty (TKA), were randomly assigned into 1 of 2 groups to determine the effect intraoperative fluoroscopy had on coronal limb alignment. Patients took part in a TKA procedure that involved fluoroscopy (group 1) or no fluoroscopy at all (group 2). Results from the study indicated that participants operated with fluoroscopy assistance experienced a lower risk of malalignment at the threshold of >3 degrees, but that operative time was significantly lengthened due to its use. Average Knee Society Score was comparable between the two groups at 1 year follow up.