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August 19, 2026The KneeOpen Access

Effect of axial alignment on patient outcomes following total knee replacement (TKR): a systematic review and meta analysis

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Authors

PKPrakrit R. KumarJVJacob VincentJGJ. Ric Gass

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Overview

Systematic review and meta-analysis finds external component rotation improves knee replacement outcomes, highlighting the need for multiplanar axial planning.

Key Points

  • To evaluate the relationship between surgical axial alignment parameters and patient-reported outcome measures following total knee replacement.
  • Searched five electronic databases through February 15, 2025, identifying 65 eligible studies comprising 8,392 total knee replacements across 8,113 patients.
  • Performed random-effects meta-regression models weighted by replacement count to analyze associations between axial parameters and PROM scores at individual, pooled, and time-adjusted levels.
  • Greater external femoral component rotation significantly improved 12-month Knee Society Score Overall (RC = 33.2, p < 0.001, n = 323), KSS-Function (RC = 11.5, p < 0.001, n = 327), and standardized PROM scores (RC = 3.38, p = 0.042, n = 1,112).
  • Higher external tibial component rotation improved 12-month KSS-Function (RC = 1.90, p = 0.030, n = 234) and time-adjusted WOMAC-Total scores (RC = -4.57, p < 0.001, n = 2,221), while lower rotational mismatch improved pooled standardized PROMs (RC = -0.55, p < 0.001, n = 786).
  • Combined component rotation showed no statistically significant association with individual, pooled, or time-adjusted PROM outcomes.

Cite This Study

Kumar et al. (2026) studied this question.

synapsesocial.com/papers/6a85639d03308d306e2d6d68https://doi.org/10.1016/j.knee.2026.104588
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