title: Does malrotation of components correlate with patient dissatisfaction following secondary patellar resurfacing?
abstract: BACKGROUND
  The aim of our study was to identify whether there was any correlation between the outcome of secondary patellar resurfacing and malrotation of either the femoral or tibial component.
  
  
  METHODS
  We identified patients that underwent secondary patellar resurfacing following previous primary total knee arthroplasty (TKA) at a single, large orthopaedic department. Patients were reviewed for range of movement, satisfaction, health status and knee function. CT scanning was performed, assessing rotational alignment of the components.
  
  
  RESULTS
  Twenty-one patients (23 knees) were reviewed. Nine out of 21 (39%) were satisfied while 14 (61%) remained dissatisfied after the secondary patellar resurfacing. There were no complications after the secondary procedure. All knees were internally rotated. The mean femoral internal rotation in the satisfied group was 0.92°, and in the dissatisfied group was 2.88° of internal rotation. In the dissatisfied group eight out of 14 TKAs were in >3° femoral internal rotation compared with only one in nine TKAs in the satisfied group (p<0.05).
  
  
  CONCLUSIONS
  Investigation for malrotation should be considered in patients with post-operative pain, especially anteriorly, causing significant dissatisfaction amongst patients following TKA. This is especially true if the patella has not been primarily resurfaced and secondary resurfacing is being considered. Patients with more than 3(°) of femoral internal rotation undergoing secondary patella resurfacing should be warned of the possibility of a poor outcome. It may well be that if the underlying problem is component malrotation, revision knee replacement may lead to a more satisfactory outcome than secondary resurfacing alone.
  
  
  METHODS
  Level of Evidence III.
authors: The Royal Bournemouth Hospital, Bournemouth, Dorset, UK. Electronic address: ghiasb@myway.com.
authors: Ghias
authors: G
authors: Bhattee
authors: The Royal Bournemouth Hospital, Bournemouth, Dorset, UK.
authors: Pradeep
authors: P
authors: Moonot
authors: The Royal Bournemouth Hospital, Bournemouth, Dorset, UK.
authors: Raj
authors: R
authors: Govindaswamy
authors: The Royal Bournemouth Hospital, Bournemouth, Dorset, UK.
authors: Andrew
authors: A
authors: Pope
authors: The Royal Bournemouth Hospital, Bournemouth, Dorset, UK.
authors: Nick
authors: N
authors: Fiddian
authors: The Royal Bournemouth Hospital, Bournemouth, Dorset, UK.
authors: Adrian
authors: A
authors: Harvey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010329:Patella / Q000601:surgery*; D017060:Patient Satisfaction; D011475:Prosthesis Failure; D012399:Rotation; D014057:Tomography, X-Ray Computed
keywords: Knee pain; Malrotation; Patellar resurfacing; Total knee arthroplasty