title: Effect of rotational alignment on outcome of total knee arthroplasty.
abstract: OBJECTIVE
  Poor outcomes have been linked to errors in rotational alignment of total knee arthroplasty components. The aims of this study were to determine the correlation between rotational alignment and outcome, to review the success of revision for malrotated total knee arthroplasty, and to determine whether evidence-based guidelines for malrotated total knee arthroplasty can be proposed.
  
  
  METHODS
  We conducted a systematic review including all studies reporting on both rotational alignment and functional outcome. Comparable studies were used in a correlation analysis and results of revision were analyzed separately.
  
  
  RESULTS
  846 studies were identified, 25 of which met the inclusion criteria. From this selection, 11 studies could be included in the correlation analysis. A medium positive correlation (ρ = 0.44, 95% CI: 0.27-0.59) and a large positive correlation (ρ = 0.68, 95% CI: 0.64-0.73) were found between external rotation of the tibial component and the femoral component, respectively, and the Knee Society score. Revision for malrotation gave positive results in all 6 studies in this field.
  
  
  CONCLUSIONS
  Medium and large positive correlations were found between tibial and femoral component rotational alignment on the one hand and better functional outcome on the other. Revision of malrotated total knee arthroplasty may be successful. However, a clear cutoff point for revision for malrotated total knee arthroplasty components could not be identified.
authors.affiliation: Departments of Orthopaedic Surgery , Amphia Hospital, Breda , the Netherlands.
authors.forename: Kars P
authors.initials: KP
authors.lastname: Valkering
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: Breugem
authors.forename: Michel Pj
authors.initials: MP
authors.lastname: van den Bekerom
authors.forename: Willem E
authors.initials: WE
authors.lastname: Tuinebreijer
authors.forename: Rutger C I
authors.initials: RC
authors.lastname: van Geenen
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D017760:Bone Malalignment / Q000517:prevention & control*; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012399:Rotation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome