ArticleArchives of orthopaedic and trauma surgery2023
Failure modes in malrotated total knee replacement.
Article in Archives of orthopaedic and trauma surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.
- Tibia rotational alignment in total knee arthroplasty: Delphi consensus statements from European Knee Society (EKS).Archives of orthopaedic and trauma surgery · 2025Pooled it
- Kinematic alignment preserves the mid-flexion trochlear line orientation in total knee arthroplasty: A prospective analysis from the FP-UCBM Knee Study Group.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Phenotyping the knee joint-A critical appraisal of CPAK for alignment classification.Journal of experimental orthopaedics · 2025Article
- Femur rotational alignment in total knee arthroplasty: Delphi consensus statements from European knee society (EKS).Archives of orthopaedic and trauma surgery · 2025Article
- Prediction of knee biomechanics with different tibial component malrotations after total knee arthroplasty: conventional machine learning vs. deep learning.Frontiers in bioengineering and biotechnology · 2023Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeAchieving normal rotational alignment of both components in total knee arthroplasty (TKA) is essential for improved knee survivorship and function. However, malrotation is a known complication resulting in higher revision rates. Understanding malrotation of the components and its concomitant clinical and functional outcomes are important for early diagnosis and management. The purpose of this study was to evaluate the effect of malrotation on clinical outcomes and failure modes in both single and combined rotational malalignment.
methodsFrom our hospital database of 364 revisions, a cohort of 76 knees with patellar maltracking, stiffness, reduced range of motion and early aseptic failure were reviewed and investigated for component malrotation using computed tomography following Berger protocol. CT findings confirmed component malrotation in 70 of these patients. Investigations included (1) measurement of femoral component malrotation using surgical transepicondylar axis, (2) measurement of tibial component malrotation using anteroposterior axis and (3) measurement of combined component rotational errors.
resultsThe correlation of CT analysis and clinical outcomes after primary TKA revealed association of patellar maltracking with femoral internal rotation, pain and instability with tibial internal rotation and knee stiffness in patients with combined component malrotation as the commonest mode of presentation. Our study showed that patients with isolated femoral, tibial and combined malrotation presented at a mean period of 3.4 ± 1.34, 1.7 ± 0.8 and 2.3 ± 0.69 years, respectively, after the index surgery. Post-revision, the mean Knee Society Score and Oxford Knee Score improved from 29.1 to 78.7, and 10.5 to 32.8, respectively, and the mean range of motion improved from 74.9 ± 24.8 to 97.1 ± 12.7 degrees at a mean follow-up of 42 months.
conclusionEarly detection of malrotation in TKA and its management with revision of both components can lead to better clinical and functional outcomes. LEVEL OF EVIDENCE: III.
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