International Orthopaedics

, Volume 36, Issue 10, pp 2067–2072 | Cite as

The effect of femoral component rotation on the five-year outcome of cemented mobile bearing total knee arthroplasty

  • Anna RienmüllerEmail author
  • Thomas Guggi
  • Gerald Gruber
  • Stefan Preiss
  • Tomas Drobny
Original Paper



Performing total knee replacement, accurate alignment and neutral rotation of the femoral component are widely believed to be crucial for the ultimate success. Contrary to absolute bone referenced alignment, using a ligament balancing technique does not automatically rotate the femoral component parallel to the transepicondylar axis. In this context we established the hypothesis that rotational alignment of the femoral component parallel to the transepicondylar axis (0° ± 3°) results in better outcome than alignment outside of this range.


We analysed 204 primary cemented mobile bearing total knee replacements five years postoperatively. Femoral component rotation was measured on axial radiographs using the condylar twist angle (CTA). Knee society score, range of motion as well as subjective rating documented outcome.


In 96 knees the femoral component rotation was within the range 0 ± 3° (neutral rotation group), and in 108 knees the five-year postoperative rotational alignment of the femoral component was outside of this range (outlier group). Postoperative CTA showed a mean of 2.8° (±3.4°) internal rotation (IR) with a range between 6° external rotation (ER) and 15° IR (CI 95). No difference with regard to subjective and objective outcome could be detected.


The present work shows that there is a large given natural variability in optimal rotational orientation, in this study between 6° ER and 15° IR, with numerous co-factors determining correct positioning of the femoral component. Further studies substantiating pre- and postoperative determinants are required to complete the understanding of resulting biomechanics in primary TKA.


Total Knee Arthroplasty External Rotation Femoral Component Knee Society Score Rotational Alignment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Anna Rienmüller
    • 1
    • 2
    Email author
  • Thomas Guggi
    • 2
  • Gerald Gruber
    • 3
  • Stefan Preiss
    • 2
  • Tomas Drobny
    • 2
  1. 1.DAL/Service d’Orthopédie et TraumatologieCHUV LausanneLausanneSwitzerland
  2. 2.Untere ExtremitätSchulthess Klinik ZürichZürichSwitzerland
  3. 3.Universitätsklinik für OrthopädieMedizinische Universität GrazGrazAustria

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