MRI evaluation of rotational alignment and synovitis in patients with pain after total knee replacement

A. M. Murakami, T. W. Hash, M. S. Hepinstall, Leonard Lyman Stephen, B. J. Nestor, H. G. Potter

Research output: Contribution to journalArticlepeer-review

51 Citations (Scopus)


Component malalignment can be associated with pain following total knee replacement (TKR). Using MRI, we reviewed 50 patients with painful TKRs and compared them with a group of 16 asymptomatic controls to determine the feasibility of using MRI in evaluating the rotational alignment of the components. Using the additional soft-tissue detail provided by this modality, we also evaluated the extent of synovitis within these two groups. Angular measurements were based on the femoral transepicondylar axis and tibial tubercle. Between two observers, there was very high interobserver agreement in the measurements of all values. Patients with painful TKRs demonstrated statistically significant relative internal rotation of the femoral component (p = 0.030). There was relative internal rotation of the tibial to femoral component and combined excessive internal rotation of the components in symptomatic knees, although these results were significant only with one of the observers (p = 0.031). There was a statistically significant association between the presence and severity of synovitis and painful TKR (p < 0.001). MRI is an effective modality in evaluating component rotational alignment.

Original languageEnglish
Pages (from-to)1209-1215
Number of pages7
JournalJournal of Bone and Joint Surgery - Series B
Volume94 B
Issue number9
Publication statusPublished - Sept 1 2012
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine


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