SpringerLink
Log in

Femoral component malrotation is not correlated with poor clinical outcomes after total knee arthroplasty

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Proper rotational alignment of the femoral component is critical for a successful total knee arthroplasty (TKA). The aim of this systematic review was to analyse the available literature to examine the effect of the TKA femoral component malrotation on clinical outcomes and assess a cut-off value for femoral rotation leading to revision surgery.

Methods

A detailed and systematic search from 1996 to 2019 of the PUBMED, Medline, Cochrane Reviews and Google Scholar databases had been performed using the keyword terms “total knee arthroplasty OR replacement” AND “femoral alignment OR malalignment OR femoral rotation OR malrotation” AND “clinical outcome”. We used the methodological index for non-randomized studies (MINORS) to identify scientifically sound articles in a reproducible format.

Results

Eleven articles met inclusion criteria. A total of 896 arthroplasties were included in this review; 409 were unexplained painful TKA patients, while 487 were painless TKA patients. The mean age of patients was 67.5 (± 2.1) years. The mean post-operative follow-up delay was 46.8 (± 32.2) months. The mean of MINORS score was 21 points indicating good methodological quality in the included studies.

Conclusions

The present review confirms that the malrotation of the femoral component in TKA does not correlate automatically to poor clinical and functional outcome. The clinical relevance of this study was that, to improve accuracy in femoral component rotation, surgeons should consider the anatomical variability of femur in each knee and perform additional measurements pre- and intra-operatively. Taking a more accurate approach will shed light on unanswered questions in unhappy TKA.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L (2001) Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 392:46–55

    Article  Google Scholar 

  2. Becker R, Bäker K, Hommel H, Bernard M, Kopf S (2018) No correlation between rotation of femoral components in the transversal plane and clinical outcome after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27(5):1456–1462

    Article  Google Scholar 

  3. Bell SW, Young P, Drury C, Smith J, Anthony I, Jones B, Blyth M, McLean A (2014) Component rotational alignment in unexplained painful primary total knee arthroplasty. Knee 21(1):272–277

    Article  Google Scholar 

  4. Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 286:40–47

    Google Scholar 

  5. Boldt JG, Stiehl JB, Hodler J, Zanetti M, Munziger U (2006) Femoral component rotation and arthrofibrosis following mobile-bearing total knee arthroplasty. Int Orthop 30(5):420–425

    Article  CAS  Google Scholar 

  6. De Valk EJ, Noorduyn JC, Mutsaerts EL (2016) How to assess femoral and tibial component rotation after total knee arthroplasty with computed tomography: a systematic review. Knee Surg Sports Traumatol Arthrosc 24(11):3517–3528

    Article  Google Scholar 

  7. Dennis DA, Komistek RD, Walker SA, Cheal EJ, Stiehl JB (2001) Femoral condylar lift-off in vivo in total knee arthroplasty. J Bone J Surg Br 83(1):33–39

    Article  CAS  Google Scholar 

  8. Huang T, Long Y, George D, Wang W (2017) Meta-analysis of gap balancing versus measured resection technique in total knee arthroplasty. Bone Joint J 99-B:151–158

    Article  CAS  Google Scholar 

  9. Hirschmann MT, Behrend H (2018) Functional knee phenotypes: a call for a more personalised and individualised approach to total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 26(10):2873–2874

    Article  Google Scholar 

  10. Hirschmann MT, Karlsson J, Becker R (2018) Hot topic: alignment in total knee arthroplasty-systematic versus more individualised alignment strategies. Knee Surg Sports Traumatol Arthrosc 26(6):1587–1588

    Article  Google Scholar 

  11. Hirschmann MT, Konala P, Amsler F, Iranpour F, Friederich NF, Cobb JP (2011) The position and orientation of total knee replacement components: a comparison of conventional radiographs, transverse 2D-CT slices and 3D-CT reconstruction. J Bone Joint Surg (Br) 93(5):629–633

    Article  CAS  Google Scholar 

  12. Insall JN, Scuderi GR, Komistek RD, Math K, Dennis DA, Anderson DT (2002) Correlation between condylar lift-off and femoral component alignment. Clin Orthop Relat Res 403:143–152

    Article  Google Scholar 

  13. Kawahara S, Okazaki K, Matsuda S, Nakahara H, Okamoto S, Iwamoto Y (2014) Internal rotation of femoral component affects functional activities after TKA—survey with the 2011 Knee Society Score. J Arthroplasty 29(12):2319–2323

    Article  Google Scholar 

  14. Kim YH, Park JW, Kim JS, Park SD (2014) The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop 38(2):379–385

    Article  Google Scholar 

  15. Larkstein D, Zarrabian M, Kosashvili Y, Gross AE, Backstein D (2010) Revision total knee arthroplasty for component malrotation is highly beneficial: a case control study. J Arthroplasty 25:1047–1052

    Article  Google Scholar 

  16. Lützner J, Kirschner S, Günther KP, Harman MK (2012) Patients with no functional improvement after total knee arthroplasty show different kinematics. Int Orthop 36(9):1841–1847

    Article  Google Scholar 

  17. Meric G, Gracitelli GC, Aram LJ, Swank ML, Bugbee WD (2015) Variability in distal femoral anatomy in patients undergoing total knee arthroplasty: measurements on 13,546 computed tomography scans. J Arthroplasty 30:1835–1838

    Article  Google Scholar 

  18. Nicoll D, Rowley DI (2010) Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg Br 92(9):1238–1244

    Article  CAS  Google Scholar 

  19. OCEBM Levels of Evidence Working Group. The Oxford levels of evidence 2. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/ocebm-level-of-evidence/

  20. Pietsch M, Hoffmann S (2012) Early revision for isolated internal malrotation of the femoral component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(6):1057–1063

    Article  Google Scholar 

  21. Rienmüller A, Guggi T, Gruber G, Preiss S, Drobny T (2012) The effect of femoral component rotation on the five-year outcome of cemented mobile bearing total knee arthroplasty. Int Orthop 36:2067–2072

    Article  Google Scholar 

  22. Schiavone Panni A, Ascione F, Rossini M, Braile A, Corona K, Vasso M, Hirschmann MT (2017) Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 26(6):1636–1644

    Article  Google Scholar 

  23. Seo JG, Kim BK, Moon YK, Kim JH, Yoon BH, Ahn TK, Lee DH (2009) Bony landmarks for determining the mechanical axis of the femur in the sagittal plane during total knee arthroplasty. Clin Orthop Surg 1:128–131

    Article  Google Scholar 

  24. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716

    Article  Google Scholar 

  25. Suter T, Zanetti M, Schmid M, Romero J (2006) Reproducibility of measurement of femoral component rotation after total knee arthroplasty using computer tomography. Arthroscopy 21:744–748

    Google Scholar 

  26. Talbot S, Dimitrious P, Radic R, Zordan R, Bartlett J (2014) The sulcus line of the troclear groove is more accurate than Whiteside’s Line in determining femoral component rotation. Knee Surg Sports Traumatol Arthrosc 23:3306–3316

    Article  Google Scholar 

  27. Thielemann FW, Konstantinids L, Herget GW, Knothe D, Helwig P, Sudkamp NP, Hauschild O (2016) Effect of rotational component alignment on clinical outcome 5–7 years after TKA With the columbus knee system. Orthopedics 39(3 Suppl):S50–S55

    Article  Google Scholar 

  28. Valkering KP, Breugem SJ, van den Bekerom MP, Tuinebreijer WE, Van Geenen RC (2015) Effect of rotational alignment on outcome of total knee arthroplasty. Acta Orthop 86(4):432–439

    Article  Google Scholar 

  29. Verlinden C, Uvin P, Labey L, Luyckx JP, Bellemans J, Vandenneucker H (2010) The influence of malrotation of the femoral component in total knee replacement on the mechanics of patellofemoral contact during gait: an in vitro biomechanical study. J Bone Joint Surg Br 92:737–742

    Article  CAS  Google Scholar 

  30. Young SW, Saffi M, Spangehl MJ, Clarke HD (2018) Unexplained pain following total knee arthroplasty: is rotational malalignment the problem. Knee 25(2):329–334

    Article  Google Scholar 

Download references

Acknowledgements

We thank Guillaume Demey to have provided us Fig. 3a, b.

Author information

Authors and Affiliations

  1. Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Via Giovanni Paolo II, Campobasso, 86100, Italy

    Katia Corona

  2. Casa di Cura “Villa Betania”, Rome, Italy

    Simone Cerciello

  3. Marrelli Hospital, Crotone, Italy

    Simone Cerciello

  4. Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University “Campana Luigi Vanvitelli”, Naples, Italy

    Michele Vasso, Giuseppe Toro, Adriano Braile & Alfredo Schiavone Panni

  5. LEONARDO – Physicians for Orthopaedic and Traumatologic Surgery, Hirslanden Clinic Birshof, 4142, Münchenstein, Basel, Switzerland

    Markus P. Arnold

Authors
  1. Katia Corona
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simone Cerciello
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michele Vasso
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giuseppe Toro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adriano Braile
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Markus P. Arnold
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alfredo Schiavone Panni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katia Corona.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

No funding has been received for this study.

Ethical approval

Ethical approval was not required for this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This work was performed at the Department of Medicine and Health “Vincenzo Tiberio”, University of Molise, Via Giovanni Paolo II, Campobasso, 86100, Italy.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Corona, K., Cerciello, S., Vasso, M. et al. Femoral component malrotation is not correlated with poor clinical outcomes after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 28, 3879–3887 (2020). https://doi.org/10.1007/s00167-020-05880-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-05880-2

Keywords

Search

Navigation