A computer-assisted, tibia-first technique for improved femoral component rotation in total knee arthroplasty

Background: The use of navigation for total knee arthroplasty (TKA) improves limb alignment in the coronal and sagittal planes. However, similar improvements in femoral and tibial component rotation have not yet been realized using currently available systems. Methods: We developed a modified navigated TKA technique in which femoral rotation was set using the resected tibial plane as the reference with the aim of achieving a rectangular flexion gap. Limb alignment was assessed in a cohort of 30 knees using the navigation system. Post-operative limb alignment was measured using long-leg standing radiographs. Computed tomography was used to determine post-operative component orientation. Results: Sagittal alignment data improved from a mean of 7.8° varus (pre-operative) to 0.0° (post-operative), assessed by intra-operative navigation. Post-operative hip-knee-ankle axis alignment was 0.9° valgus (mean; standard deviation [SD] 1.7°). Mean femoral component rotation was 0.5° internally rotated (SD 2.6°), relative to the surgical transepicondylar axis. Mean tibial component rotation was 0.9° externally rotated (SD 5.5°). No soft tissue releases were performed. Conclusions: These results confirm that the desired femoral rotation, set using a tibia-first approach with the resected tibial plane as the reference, can be achieved without compromising overall limb alignment. Femoral component rotation was within a narrow range, with a moderate improvement in achieving more consistent tibial component rotation compared with other techniques. This technique may prove to be useful for surgeons wishing to employ a tibia-first philosophy for TKA while maximizing the benefits associated with computer-assisted navigation. Keywords: Total knee arthroplasty, Navigation, Rotation, Tibia first, Rotation, Alignmen