Abstract
Femoral rotation positioning is critical for successful total knee arthroplasty (TKA). There are three generally accepted methods of referencing femoral component rotational alignment. These include the transepicondylar axis (TEA), as advocated by Insall, arbitrary external rotation from the posterior condyles, and the so-called Whiteside line. Another less well recognized method, which has been used for over 25 years, is referencing femoral component rotation perpendicular to the tibial shaft axis via a balanced flexion tension gap. Placing the femoral component parallel to the TEA leads to a bio-mechanically sound knee motion in full flexion and extension. However, this method has potential errors that include any anatomical deviations of the distal femur, which may occur in cases with severe varus or valgus angle deformity, condylar dysplasia, or other rotational pathology of the lower extremity.
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