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 .
Neutral alignment leads to higher knee society scores after total knee arthroplasty in preoperatively non-varus patients: a prospective clinical study using 3D-CT
Purpose The optimal coronal alignment is still under debate . However , in most of the studies , alignment was only assessed using radiographs , which are not accurate enough for assessment of tibial and femoral TKA position . The primary purpose of this study was to assess the relationship between coronal TKA alignment using 3D-reconstructed CTs and clinical outcome in patients with preoperative varus in comparison with patients with natural or valgus deformity . It was the hypothesis that neutral limb alignment shows a better outcome after TKA . Methods Prospect ively collected data of 38 patients were included . The clinical and radiological follow-up was 24 months . The patients were grouped into two groups with regard to their preoperative limb alignment . Group A ( varus ) consisted of 21 patients with preoperative varus of 3 ° or more , while group B ( non-varus ) consisted of 17 patients with  neutral  ( − 3 < 0 > + 3 ) or valgus alignment ( > + 3 ) . For assessment of TKA component position and orientation , 3D-reconstructed CT was used . The measurements of the deviation from the whole limb mechanical axis ( HKA angle ) and the joint line alignment in the femoral ( mLDFA ) and the tibial side ( MPTA ) were assessed in the preoperative leg as well as during follow-up after TKA . For clinical outcome assessment , the Knee Society Score ( KSS ) was used at 1 and 2 years postoperatively . Correlation between KSS score and each variable was done using a linear and quadratic regression model ( p < 0.05 ) . Results The mean postoperative HKA angle was − 1.3 ( varus ) in the varus group and + 1.4 ( valgus ) in the non-varus group . Overall , significant correlations between the preoperative and postoperative alignments were found . In the preoperatively non-varus group , a highly significant correlation was found between neutral limb alignment ( HKA = 0 ° ± 3 ° ) and higher KSS ( r2 = 0.74 , p = 0.00 ) . In the varus group , no correlation was found between the postoperative whole limb alignment and the components ’ position in the coronal plane to KSS score . Conclusion A significant correlation was found between neutral limb alignment and higher KSS only in patients with preoperative non-varus alignment . The concept of constitutional varus alignment is still under debate . Moreover , it appears that one should aim for a more individualized , alignment target based on the individual knee morphotype . Level of evidence Diagnostic study , Level 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 .