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Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review

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

Abstract

Purpose

The aim of this systematic review is to analyze the effect of tibial rotational alignment after total knee arthroplasty (TKA) on clinical outcomes and assess the eventual cut-off values for tibial TKA rotation leading to poor outcomes.

Methods

A detailed and systematic search from 1997 to 2017 of the Pubmed, Medline, Cochrane Reviews, and the Google Scholar databases was performed using the keyword terms “total knee arthroplasty”, “total knee replacement”, “tibial alignment”, “tibial malalignement”, “tibial rotation”, “rotational error”, “axis”, “angle”, “tibial malrotation”, “clinical outcome”, in several combinations. The modified Coleman scoring methodology (mCMS) was used. All the primary TKAs studies analyzing correlation between clinical results and tibial rotation were included.

Results

Five articles met the inclusion criteria. A total of 333 arthroplasties were included in this review; 139 had tibial component malalignment, while 194 were in control groups. The mean age of patients was 67.3 (SD 0.57) years. The mean average postoperative follow-up delay was 34.7 months (range 21–70). The mean mCMS score was 59.2 points indicating good methodological quality in the included studies. Functional outcomes were assessed through KSS, OKS, KOOS and VAS, negatively related to tibial internal rotation.

Conclusions

Our review confirmed that excessive internal rotation of the tibial TKA component represents a significant risk factor for pain and inferior functional outcomes after TKA (> 10° of internal rotation demonstrated the common value), since external rotation does not affect the results. However, a universal precise cut-off value has not been found in the available literature and there remains a debate about CT rotation assessment and surgical intra-operative landmarks.

Level of evidence

III.

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Author information

Authors and Affiliations

  1. Multidisciplinary Department of Orthopedic and Dentistry Specialties, Università della Campania “Luigi Vanvitelli”, Naples, Italy

    Alfredo Schiavone Panni, Francesco Ascione, Marco Rossini, Adriano Braile & Michele Vasso

  2. Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy

    Francesco Ascione

  3. Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy

    Katia Corona

  4. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland

    Michael T. Hirschmann

  5. University of Basel, Basel, Switzerland

    Michael T. Hirschmann

Authors
  1. Alfredo Schiavone Panni
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  2. Francesco Ascione
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  3. Marco Rossini
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  4. Adriano Braile
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  5. Katia Corona
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  6. Michele Vasso
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  7. Michael T. Hirschmann
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Correspondence to Francesco Ascione.

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The authors declare that they have no conflicts of interest.

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No funding has been received for this study.

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Ethical approval was not required for this study.

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Panni, A.S., Ascione, F., Rossini, M. et al. Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 26, 1636–1644 (2018). https://doi.org/10.1007/s00167-017-4823-0

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  • DOI: https://doi.org/10.1007/s00167-017-4823-0

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