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CONCLUSIONS The risk of early loss in the IL group was higher than that in the DL group. For removable prostheses and nonsplinted implants, DL was preferred. The quality of scientific evidence significantly favors DL. BACKGROUND Femorotibial rotational mismatch has been reported to cause unsatisfactory outcomes after total knee arthroplasty. However, to our knowledge, no previous reports have described the relationship between the femorotibial rotational mismatch and clinical outcomes of Oxford unicompartmental knee arthroplasty (UKA).