The EKA Femoral Rotation Focus Group has not identified a single best reference method to determine femoral component rotation , but surgeons mostly prefer the measured resection technique using at least two l and marks for cross-checking the rotation .
Malrotation of the femoral component after primary total knee arthroplasty ( TKA ) is one of the most important problems leading to painful TKA requiring revision surgery .
A comprehensive systematic review of the literature was performed to present current evidence on how to optimally place the femoral component in TKA .
No difference between tibia-first and femur-first techniques in TKA using computer-assisted surgery
Purpose The measured resection technique and the gap-balancing technique are two philosophies used in total knee surgery . It is still unknown whether one or the other technique provides superior results when computer-assisted surgery is performed . We hypothesized that the gap-balancing technique improves joint stability because the technique relies primarily on the soft tissue . Methods A prospect i ve controlled study was performed in 116 patients using the tibia-first or femur-first technique .  The ColumbusTM total knee system and the Orthopilot ® ( Aesculap ® AG , Tuttlingen , Germany ) navigation system were used in all cases . Sixty-three patients were allocated to the femur-first technique ( group F ) and 53 patients to the tibial first technique ( group T ) . The mean follow-up time was 11.4 ± 1.1 months . The KSS , KOOS and SF-36 were taken prior to surgery and at the time of follow-up for clinical assessment . Long-leg weight-bearing radiographs were performed to assess ligament alignment . Radiographs in varus and valgus stress were performed using the Telos ® -Instrument ( Telos ® GmbH , Greisheim , Germany ) under a force of 15 N at the time of follow-up for the assessment of medial – lateral stability . The nonparametric t test ( Mann – Whitney U-test ) was used in order to compare the ligament stability and the scores between group F and group T. Results The lateral joint space opening for groups F and T was 3.4 ° ± 1.4 ° and 3.9 ° ± 1.7 ° , respectively ( n.s . ) , and the medial joint space opening for groups F and T was 4 ° ± 1.4 ° and 4.1 ° ± 1.7 ° , respectively ( n.s . ) . The femorotibial mechanical axis for groups F and T revealed 1.4 ° ± 1.2 ° and 0.7 ° ± 2.0 ° of varus , respectively ( p = 0.138 ) . The clinical assessment showed significant improvement according to KSS , KOOS and SF-36 in all subscales . Neither of the sores showed significant differences between the two groups . Conclusion The surgeon should use his/her preferred surgical technique providing the implantation is performed with computer assistance . It remains unclear whether the same findings will occur after conventional surgery . Level of evidence II
The EKA Femoral Rotation Focus Group has not identified a single best reference method to determine femoral component rotation , but surgeons mostly prefer the measured resection technique using at least two l and marks for cross-checking the rotation .
Malrotation of the femoral component after primary total knee arthroplasty ( TKA ) is one of the most important problems leading to painful TKA requiring revision surgery .
A comprehensive systematic review of the literature was performed to present current evidence on how to optimally place the femoral component in TKA .