Rotational Alignment of the Femoral Component in Total Knee Replacement: Ligament Balance, Tibial Reference, and Femoral Component Sizing

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In total knee replacement, patellar tracking and ligament balance in flexion are affected by the rotational alignment of the femoral component. Due to variations in human knee anatomy, satisfactory rotational alignment can be difficult to determine from femoral landmarks, especially the posterior condyles. Cutting the distal and posterior femoral condyles parallel to a perpendicular proximal tibial cut (tibial reference) is a practical and effective alternative. The method is prone to error when the femoral cuts are made before the ligaments are appropriately mobilized, if the femoral component is too large or if the joint line is raised. The steps described here are intended to address and control these specific problems using instrumentation available in most knee replacement sets.

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