No Consensus on the Role of Component Rotation in Postoperative Outcomes After Total Knee Arthroplasty: A Systematic Review

Abstract: Up to 20% of patients report dissatisfaction after total knee arthroplasty (TKA), often due to unexplained long-term pain. Component malrotation has been proposed as a contributing factor. This systematic review aimed to evaluate the association between component malrotation and patient-reported outcome measures (PROMs). A systematic search was conducted in PubMed/Medline, Embase, and the Cochrane Library. Studies assessing the effect of femoral, tibial, combined rotation, or rotational mismatch on PROMs were included. Methodological quality was assessed using the Joanna Briggs Institute manual, and evidence levels were assigned based on the Oxford Levels of Evidence. A total of 22 studies involving 1,943 patients met the inclusion criteria. No consistent association was found between component rotation, whether femoral, tibial, combined, or mismatch, and PROMs. There is no clear consensus on the impact of component malrotation on PROMs. However, combined malrotation and rotational mismatch may influence outcomes more than isolated femoral or tibial rotation. Further, high-quality, Level 1 studies are needed to define optimal rotational alignment in TKA.