Component rotational mismatch in the standing position is a potential risk factor for unfavourable functional outcomes after total knee arthroplasty

Purpose This study assessed rotational mismatch between components after total knee arthroplasty (TKA) in the supine and standing positions and aimed to investigate the effect of rotational mismatch in the standing position on postoperative patient‐reported outcome measures (PROMs). Methods Seventy‐...

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Published in:Journal of experimental orthopaedics 2024-07, Vol.11 (3), p.e12069-n/a
Main Authors: Kokubu, Yasuhiko, Kawahara, Shinya, Mizu‐Uchi, Hideki, Hamai, Satoshi, Akasaki, Yukio, Sato, Taishi, Ishibashi, Shojiro, Konishi, Toshiki, Nakashima, Yasuharu
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rotational mismatch
standing position
total knee arthroplasty
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creator Kokubu, Yasuhiko
Kawahara, Shinya
Mizu‐Uchi, Hideki
Hamai, Satoshi
Akasaki, Yukio
Sato, Taishi
Ishibashi, Shojiro
Konishi, Toshiki
Nakashima, Yasuharu
description Purpose This study assessed rotational mismatch between components after total knee arthroplasty (TKA) in the supine and standing positions and aimed to investigate the effect of rotational mismatch in the standing position on postoperative patient‐reported outcome measures (PROMs). Methods Seventy‐one patients (71 knees) who underwent TKA for medial knee osteoarthritis were used to investigate rotational mismatches between components. Rotational mismatches between components were examined on postoperative standing whole‐leg and supine knee radiographs using a three‐dimensional‐to‐two‐dimensional model image registration technique, and the angles between the reference axes of the components were measured. Component alignment was evaluated using postoperative computed tomography images, and a questionnaire (2011 version of the Knee Society Score: [KSS 2011]) was mailed to investigate postoperative PROMs. Results In the entire cohort, rotational mismatches in the supine and standing positions were similar (p = 0.9315). In 15% of patients, the mismatch was large (>5°) in the supine position but small (
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Methods Seventy‐one patients (71 knees) who underwent TKA for medial knee osteoarthritis were used to investigate rotational mismatches between components. Rotational mismatches between components were examined on postoperative standing whole‐leg and supine knee radiographs using a three‐dimensional‐to‐two‐dimensional model image registration technique, and the angles between the reference axes of the components were measured. Component alignment was evaluated using postoperative computed tomography images, and a questionnaire (2011 version of the Knee Society Score: [KSS 2011]) was mailed to investigate postoperative PROMs. Results In the entire cohort, rotational mismatches in the supine and standing positions were similar (p = 0.9315). In 15% of patients, the mismatch was large (&gt;5°) in the supine position but small (&lt;5°) in the standing position (overestimated group). However, in 23% of patients, the mismatch was small (&lt;5°) in the supine position and large (&gt;5°) in the standing position (underestimated group). The underestimated group had severe preoperative varus deformity, resulting in external rotation of both femoral and tibial components. Rotational mismatch in the standing position (p = 0.0032) was a significant risk factor for unfavourable PROMs. Patients with a mismatch in the standing position had significantly lower scores than those without a mismatch (p = 0.0215), exceeding the minimal clinically important difference values. Conclusions The underestimated group is clinically important because the surgical procedure and intraoperative assessment of component placement are performed in the supine position. In cases of severe preoperative varus deformity, care should be taken not to place the component in malrotation to avoid rotational mismatch in the standing position. Level of Evidence Ⅳ, Case series.</description><identifier>ISSN: 2197-1153</identifier><identifier>EISSN: 2197-1153</identifier><identifier>DOI: 10.1002/jeo2.12069</identifier><identifier>PMID: 38957227</identifier><language>eng</language><publisher>United States: John Wiley and Sons Inc</publisher><subject>Original Paper ; Original Papers ; rotational mismatch ; standing position ; total knee arthroplasty</subject><ispartof>Journal of experimental orthopaedics, 2024-07, Vol.11 (3), p.e12069-n/a</ispartof><rights>2024 The Author(s). published by John Wiley &amp; Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.</rights><rights>2024 The Author(s). Journal of Experimental Orthopaedics published by John Wiley &amp; Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c4109-dc00808466757bab844de0dd0d67ef570483f8ce9f36a2d56fff3e38bb947b013</cites><orcidid>0000-0001-6264-300X ; 0000-0001-9229-6205</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11217670/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11217670/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,11540,27900,27901,36989,46026,46450,53765,53767</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38957227$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kokubu, Yasuhiko</creatorcontrib><creatorcontrib>Kawahara, Shinya</creatorcontrib><creatorcontrib>Mizu‐Uchi, Hideki</creatorcontrib><creatorcontrib>Hamai, Satoshi</creatorcontrib><creatorcontrib>Akasaki, Yukio</creatorcontrib><creatorcontrib>Sato, Taishi</creatorcontrib><creatorcontrib>Ishibashi, Shojiro</creatorcontrib><creatorcontrib>Konishi, Toshiki</creatorcontrib><creatorcontrib>Nakashima, Yasuharu</creatorcontrib><title>Component rotational mismatch in the standing position is a potential risk factor for unfavourable functional outcomes after total knee arthroplasty</title><title>Journal of experimental orthopaedics</title><addtitle>J Exp Orthop</addtitle><description>Purpose This study assessed rotational mismatch between components after total knee arthroplasty (TKA) in the supine and standing positions and aimed to investigate the effect of rotational mismatch in the standing position on postoperative patient‐reported outcome measures (PROMs). Methods Seventy‐one patients (71 knees) who underwent TKA for medial knee osteoarthritis were used to investigate rotational mismatches between components. Rotational mismatches between components were examined on postoperative standing whole‐leg and supine knee radiographs using a three‐dimensional‐to‐two‐dimensional model image registration technique, and the angles between the reference axes of the components were measured. Component alignment was evaluated using postoperative computed tomography images, and a questionnaire (2011 version of the Knee Society Score: [KSS 2011]) was mailed to investigate postoperative PROMs. Results In the entire cohort, rotational mismatches in the supine and standing positions were similar (p = 0.9315). In 15% of patients, the mismatch was large (&gt;5°) in the supine position but small (&lt;5°) in the standing position (overestimated group). However, in 23% of patients, the mismatch was small (&lt;5°) in the supine position and large (&gt;5°) in the standing position (underestimated group). The underestimated group had severe preoperative varus deformity, resulting in external rotation of both femoral and tibial components. Rotational mismatch in the standing position (p = 0.0032) was a significant risk factor for unfavourable PROMs. Patients with a mismatch in the standing position had significantly lower scores than those without a mismatch (p = 0.0215), exceeding the minimal clinically important difference values. Conclusions The underestimated group is clinically important because the surgical procedure and intraoperative assessment of component placement are performed in the supine position. In cases of severe preoperative varus deformity, care should be taken not to place the component in malrotation to avoid rotational mismatch in the standing position. Level of Evidence Ⅳ, Case series.</description><subject>Original Paper</subject><subject>Original Papers</subject><subject>rotational mismatch</subject><subject>standing position</subject><subject>total knee arthroplasty</subject><issn>2197-1153</issn><issn>2197-1153</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>DOA</sourceid><recordid>eNp9kt9uFCEUxonR2GbtjQ9guDQmWw_DDDBXxmyq1jTpjV4ThoFdtjMwAlOz7-EDy3bWpr3xgj8HvvM7J_Ah9JbAJQGoPu5NqC5JBax9gc4r0vI1IQ19-WR_hi5S2gMAoTU0jL9GZ1S0Da8qfo7-bMI4BW98xjFklV3wasCjS6PKeoedx3lncMrK985v8RSSO2qwS1iVKJdEVxKiS3fYKp1DxLaM2Vt1H-aousFgO3t9Aoc56zCakmyziTiXkgO-88ZgFfMuhmlQKR_eoFdWDclcnNYV-vnl6sfm2_rm9uv15vPNWtcE2nWvAQSImjHe8E51oq57A30PPePGNhxqQa3QprWUqapvmLWWGiq6rq15V55jha4Xbh_UXk7RjSoeZFBOPhyEuJWlLacHI3vOoW11x7WAmrXQEko7yqwSTFNRghX6tLCmuRtNr8vDRDU8gz6_8W4nt-FeElIRzjgUwvsTIYZfs0lZlm_QZhiUN2FOkgJvKBfHeYU-LFIdQ0rR2Mc6BOTRFvJoC_lgiyJ-97SzR-k_ExQBWQS_3WAO_0HJ71e31QL9C6AzxiQ</recordid><startdate>202407</startdate><enddate>202407</enddate><creator>Kokubu, Yasuhiko</creator><creator>Kawahara, Shinya</creator><creator>Mizu‐Uchi, Hideki</creator><creator>Hamai, Satoshi</creator><creator>Akasaki, Yukio</creator><creator>Sato, Taishi</creator><creator>Ishibashi, Shojiro</creator><creator>Konishi, Toshiki</creator><creator>Nakashima, Yasuharu</creator><general>John Wiley and Sons Inc</general><general>Wiley</general><scope>24P</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-6264-300X</orcidid><orcidid>https://orcid.org/0000-0001-9229-6205</orcidid></search><sort><creationdate>202407</creationdate><title>Component rotational mismatch in the standing position is a potential risk factor for unfavourable functional outcomes after total knee arthroplasty</title><author>Kokubu, Yasuhiko ; Kawahara, Shinya ; Mizu‐Uchi, Hideki ; Hamai, Satoshi ; Akasaki, Yukio ; Sato, Taishi ; Ishibashi, Shojiro ; Konishi, Toshiki ; Nakashima, Yasuharu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4109-dc00808466757bab844de0dd0d67ef570483f8ce9f36a2d56fff3e38bb947b013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Original Paper</topic><topic>Original Papers</topic><topic>rotational mismatch</topic><topic>standing position</topic><topic>total knee arthroplasty</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kokubu, Yasuhiko</creatorcontrib><creatorcontrib>Kawahara, Shinya</creatorcontrib><creatorcontrib>Mizu‐Uchi, Hideki</creatorcontrib><creatorcontrib>Hamai, Satoshi</creatorcontrib><creatorcontrib>Akasaki, Yukio</creatorcontrib><creatorcontrib>Sato, Taishi</creatorcontrib><creatorcontrib>Ishibashi, Shojiro</creatorcontrib><creatorcontrib>Konishi, Toshiki</creatorcontrib><creatorcontrib>Nakashima, Yasuharu</creatorcontrib><collection>Wiley-Blackwell Open Access Collection</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>Journal of experimental orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kokubu, Yasuhiko</au><au>Kawahara, Shinya</au><au>Mizu‐Uchi, Hideki</au><au>Hamai, Satoshi</au><au>Akasaki, Yukio</au><au>Sato, Taishi</au><au>Ishibashi, Shojiro</au><au>Konishi, Toshiki</au><au>Nakashima, Yasuharu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Component rotational mismatch in the standing position is a potential risk factor for unfavourable functional outcomes after total knee arthroplasty</atitle><jtitle>Journal of experimental orthopaedics</jtitle><addtitle>J Exp Orthop</addtitle><date>2024-07</date><risdate>2024</risdate><volume>11</volume><issue>3</issue><spage>e12069</spage><epage>n/a</epage><pages>e12069-n/a</pages><issn>2197-1153</issn><eissn>2197-1153</eissn><abstract>Purpose This study assessed rotational mismatch between components after total knee arthroplasty (TKA) in the supine and standing positions and aimed to investigate the effect of rotational mismatch in the standing position on postoperative patient‐reported outcome measures (PROMs). Methods Seventy‐one patients (71 knees) who underwent TKA for medial knee osteoarthritis were used to investigate rotational mismatches between components. Rotational mismatches between components were examined on postoperative standing whole‐leg and supine knee radiographs using a three‐dimensional‐to‐two‐dimensional model image registration technique, and the angles between the reference axes of the components were measured. Component alignment was evaluated using postoperative computed tomography images, and a questionnaire (2011 version of the Knee Society Score: [KSS 2011]) was mailed to investigate postoperative PROMs. Results In the entire cohort, rotational mismatches in the supine and standing positions were similar (p = 0.9315). In 15% of patients, the mismatch was large (&gt;5°) in the supine position but small (&lt;5°) in the standing position (overestimated group). However, in 23% of patients, the mismatch was small (&lt;5°) in the supine position and large (&gt;5°) in the standing position (underestimated group). The underestimated group had severe preoperative varus deformity, resulting in external rotation of both femoral and tibial components. Rotational mismatch in the standing position (p = 0.0032) was a significant risk factor for unfavourable PROMs. Patients with a mismatch in the standing position had significantly lower scores than those without a mismatch (p = 0.0215), exceeding the minimal clinically important difference values. Conclusions The underestimated group is clinically important because the surgical procedure and intraoperative assessment of component placement are performed in the supine position. In cases of severe preoperative varus deformity, care should be taken not to place the component in malrotation to avoid rotational mismatch in the standing position. Level of Evidence Ⅳ, Case series.</abstract><cop>United States</cop><pub>John Wiley and Sons Inc</pub><pmid>38957227</pmid><doi>10.1002/jeo2.12069</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0001-6264-300X</orcidid><orcidid>https://orcid.org/0000-0001-9229-6205</orcidid><oa>free_for_read</oa></addata></record>
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subjects Original Paper
Original Papers
rotational mismatch
standing position
total knee arthroplasty
title Component rotational mismatch in the standing position is a potential risk factor for unfavourable functional outcomes after total knee arthroplasty
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