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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2012

01-06-2012 | Knee

Early revision for isolated internal malrotation of the femoral component in total knee arthroplasty

Authors: Martin Pietsch, Siegfried Hofmann

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2012

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Abstract

Purpose

In this prospective study, we determined whether corrective surgery for isolated rotational malalignment of femoral prosthesis components would benefit patients previously treated with total knee arthroplasty. The symptoms, amount of malrotation and type of constraint necessary for the revision prosthesis were investigated.

Methods

Seventy-two patients were screened with computed tomography; of these, 14 had isolated internal malrotation of the femoral component with no other malpositions and were included in the study. A complete exchange arthroplasty with the correction of the malrotated femoral component was performed within 3 years of primary arthroplasty. Mean follow-up was 57 months.

Results

At the time of revision, patients suffered either from instability in flexion with good range of motion (ROM) (flexion ≥90°) and pain on the lateral side of the distal femur and proximal tibia (n = 8) or from stiffness with pain on the medial side of the proximal tibial and poor ROM (flexion <90°) (n = 6). One patient showed no patellar maltracking, six patients, patellar tilt and six patients, patellar subluxation. Median internal rotation of the femoral component was 7.1° (4.1–10.0°). A condylar-type revision implant with a posterior-stabilized insert was used in all patients. The corrective surgery resulted in an increase in the mean Knee Society Score from 52/65 to 85/84 points and an improvement in the mean Hospital for Special Surgery knee score from 63 to 83 points.

Conclusions

Correction of isolated internal malrotation of the femoral component ≥4° improves patient outcome.
Literature
1.
Anouchi YS, Whiteside LA, Kaiser AD et al (1993) The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens. Clin Orthop Relat Res 287:170–177PubMed
2.
Barrack RL, Schrader T, Bertot AJ et al (2001) Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 392:46–55PubMedCrossRef
3.
Berger RA, Crossett LS, Jacobs JJ et al (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 356:144–153PubMedCrossRef
4.
Boldt JG, Stiehl JB, Hodler J et al (2006) Femoral component rotation and arthrofibrosis following mobile-bearing total knee arthroplasty. Int Orthop 30:420–425PubMedCrossRef
5.
Emmerson KP, Moran CG, Pinder IM (1996) Survivorship analysis of the kinematic stabilizer total knee replacement: a 10–14-year follow-up. J Bone Jt Surg Br 78:441–445
6.
Fehring TK, Odum S, Griffin WL et al (2001) Early failures in total knee arthroplasty. Clin Orthop Relat Res 392:315–318PubMedCrossRef
7.
Fink B, Makowiak C, Fuerst M et al (2008) The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Jt Surg Br 90:874–878CrossRef
8.
Gomes LS, Bechtold JE, Gustilo RB (1988) Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study. Clin Orthop Relat Res 236:72–81PubMed
9.
Heck DA, Melfi CA, Mamlin LA et al (1998) Revision rates after knee replacement in the United States. Med Care 36:661–669PubMedCrossRef
10.
Hofmann S, Romero J, Roth-Schiffl E et al (2003) Rotational malalignment of the components may cause chronic pain or early failure in total knee arthroplasty. Orthopade 32:469–476PubMed
11.
Incavo SJ, Wild JJ, Coughlin KM et al (2007) Early revision for component malrotation in total knee arthroplasty. Clin Orthop Relat Res 458:131–136PubMed
12.
Insall JN, Dorr LD, Scott RD et al (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14PubMed
13.
Insall JN, Ranawat CS, Aglietti P et al (1976) A comparison of four models of total knee-replacement prostheses. J Bone Jt Surg Am 58:754–765
14.
Insall JN, Scuderi GR, Komistek RD et al (2002) Correlation between condylar lift-off and femoral component alignment. Clin Orthop Relat Res 403:143–152PubMedCrossRef
15.
Kelly MA, Clarke HD (2002) Long-term results of posterior cruciate-substituting total knee arthroplasty. Clin Orthop Relat Res 404:51–57PubMedCrossRef
16.
Lakstein D, Zarrabian M, Kosashvili Y et al (2010) Revision total knee arthroplasty for component malrotation is highly beneficial: a case control study. J Arthroplast 25:1047–1052CrossRef
17.
Laskin RS (1995) Flexion space configuration in total knee arthroplasty. J Arthroplast 10:657–660CrossRef
18.
Luring C, Perlick L, Bathis H et al (2007) The effect of femoral component rotation on patellar tracking in total knee arthroplasty. Orthopedics 30:965–967PubMed
19.
Matziolis G, Boenicke H, Pfiel S et al (2010) The gap technique does not rotate the femur parallel to the epicondylar axis. Arch Orthop Trauma Surg 131(2):163–166PubMedCrossRef
20.
Merchant AC, Mercer RL, Jacobsen RH et al (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Jt Surg Am 56:1391–1396
21.
Noble PC, Conditt MA, Cook KF et al (2006) The John Insall award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43PubMedCrossRef
22.
Paley D, Tetsworth K (1992) Mechanical axis deviation of the lower limbs. Preoperative planning of multiapical frontal plane angular and bowing deformities of the femur and tibia. Clin Orthop Relat Res 280:65–71PubMed
23.
Ranawat CS, Luessenhop CP, Rodriguez JA (1997) The press-fit condylar modular total knee system. Four–six-year results with a posterior-cruciate-substituting design. J Bone Jt Surg Am 79:342–348
24.
Robertsson O, Knutson K, Lewold S et al (2001) The Swedish knee arthroplasty register 1975–1997: an update with special emphasis on 41, 223 knees operated on in 1988–1997. Acta Orthop Scand 72:503–513PubMedCrossRef
25.
Romero J, Duronio JF, Sohrabi A et al (2002) Varus and valgus flexion laxity of total knee alignment methods in loaded cadaveric knees. Clin Orthop Relat Res 394:243–253PubMedCrossRef
26.
Romero J, Stahelin T, Binkert C et al (2007) The clinical consequences of flexion gap asymmetry in total knee arthroplasty. J Arthroplast 22:235–240CrossRef
27.
Romero J, Stahelin T, Wyss T et al (2003) Significance of axial rotation alignment of components of knee prostheses. Orthopade 32:461–468PubMed
28.
Scuderi GR, Komistek RD, Dennis DA et al (2003) The impact of femoral component rotational alignment on condylar lift-off. Clin Orthop Relat Res 410:148–154PubMedCrossRef
29.
Sharkey PF, Hozack WJ, Rothman RH et al (2002) Insall award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13PubMedCrossRef
30.
Stahelin T, Kessler O, Pfirrmann C et al (2003) Fluoroscopically assisted stress radiography for varus-valgus stability assessment in flexion after total knee arthroplasty. J Arthroplast 18:513–515CrossRef
Metadata
Title
Early revision for isolated internal malrotation of the femoral component in total knee arthroplasty
Authors
Martin Pietsch
Siegfried Hofmann
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2012
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1637-3

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