{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T13:46:09Z","timestamp":1782481569820,"version":"3.54.5"},"reference-count":42,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"abstract":"Abstract<\/jats:title>\n \n Purpose<\/jats:title>\n Femoral component internal rotation tightens the medial flexion gap and medialises femoral trochlea position, thus influencing patellofemoral tracking and function. Therefore, one of the tenets of mechanically aligned total knee arthroplasty (TKA) has been to avoid femoral component internal rotation relative to the transepicondylar axis (TEA). Our aim was to describe femoral component rotation achieved in functionally aligned TKA and assess the impact of femoral component rotation on functional outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective review of 2760 consecutive, functionally aligned (FA), robotic\u2010assisted TKAs, undertaken by two senior arthroplasty surgeons was performed. Femoral component rotation was assessed relative to the surgical TEA (sTEA) at the time of implantation using an image\u2010based TKA system. Primary outcomes were Forgotten Joint Score (FJS) and knee flexion range of motion (ROM) at 1 year follow\u2010up. Secondary outcomes were knee extension, EuroQol 5\u2010Dimension Score, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Oxford Knee Score and Visual Analogue Scale pain.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Mean femoral component rotation was 0.3\u00b0 (standard deviation 2.1, range 6.9 internally rotated to 6.5 externally rotated) external to the sTEA. The femoral component was\u2009>2\u00b0 internally rotated to the sTEA in 332 (12%) cases and >4\u00b0 in 66 (2%) cases. It was rare for the femoral component to be more than 2\u00b0 internally rotated to the preoperative native posterior condylar axis (0.5%,\n n<\/jats:italic>\n \u2009=\u200913). When comparing patients with femoral component internally rotated more than 2\u00b0 to the sTEA to all other patients, there was no statistically nor clinically relevant difference in any outcome measure at 1 year follow\u2010up. Multivariate analysis found femoral component rotation to have no significant correlation with postoperative FJS or flexion ROM.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Internally rotating the femoral component relative to the surgical TEA, in a functionally aligned TKA, was not associated with any detrimental impact on clinical outcomes. The ongoing study of alternative alignment strategies that result in relative internal rotation of the femoral component is warranted.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level III, retrospective comparative study.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ksa.70509","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T12:49:36Z","timestamp":1782478176000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Femoral component internal rotation in functionally aligned robotic\u2010assisted total knee arthroplasty does not impair functional outcomes"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9914-1011","authenticated-orcid":false,"given":"Andrew","family":"Philpott","sequence":"first","affiliation":[{"name":"Department of Orthopaedics Austin Hospital Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7796-6047","authenticated-orcid":false,"given":"Anton","family":"Lambers","sequence":"additional","affiliation":[{"name":"Medical School The University of Western Australia Perth Western Australia Australia"},{"name":"Department of Orthopaedics Northeast Health Wangaratta Wangaratta Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4425-4529","authenticated-orcid":false,"given":"Serene","family":"Lee","sequence":"additional","affiliation":[{"name":"Perth Hip and Knee Clinic Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0554-4106","authenticated-orcid":false,"given":"Dermot","family":"Collopy","sequence":"additional","affiliation":[{"name":"Perth Hip and Knee Clinic Perth Australia"},{"name":"St John of God Subiaco Murdoch and Midland Hospitals Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3967-1613","authenticated-orcid":false,"given":"Gavin","family":"Clark","sequence":"additional","affiliation":[{"name":"Perth Hip and Knee Clinic Perth Australia"},{"name":"St John of God Subiaco Murdoch and Midland Hospitals Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"issue":"1","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s43019-019-0006-2","article-title":"All types of component malrotation affect the early patient\u2010reported outcome measures after total knee arthroplasty","volume":"31","author":"Abdelnasser MK","year":"2019","journal-title":"Knee Surg Relat Res"},{"key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/00003086-200403000-00030","article-title":"An anteroposterior axis of the tibia for total knee arthroplasty","volume":"420","author":"Akagi M","year":"2004","journal-title":"Clin Orthop Relat Res"},{"issue":"11","key":"e_1_2_14_4_1","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1111\/ans.12708","article-title":"Defining distal femoral anatomy for rotational alignment in total knee arthroplasty: a magnetic resonance imaging\u2010based study","volume":"84","author":"Amaranath JE","year":"2014","journal-title":"ANZ J Surg"},{"key":"e_1_2_14_5_1","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/00003086-199302000-00027","article-title":"The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens","volume":"287","author":"Anouchi YS","year":"1993","journal-title":"Clin Orthop"},{"issue":"7","key":"e_1_2_14_6_1","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1016\/j.arth.2019.02.056","article-title":"Knee arthroplasty component malrotation does not affect function or quality of life in the short to medium term","volume":"34","author":"Babazadeh S","year":"2019","journal-title":"J Arthroplasty"},{"issue":"9","key":"e_1_2_14_7_1","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1016\/j.jbiomech.2005.04.027","article-title":"The difference in trochlear orientation between the natural knee and current prosthetic knee designs; 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