Specifics of femoral component rotation in total knee arthroplasty: a review

Optimal rotational alignment of the femoral component is critical in total knee arthroplasty. The measured resection technique, gap-balancing technique, and hybrid approach are available intraoperative methods for determining femoral rotation; however, each has distinct advantages and limitations. This review aimed to examine the potential of preoperative planning, assess the impact of femoral component malrotation and its acceptable limits on surgical outcomes, and determine the feasibility of using standard intraoperative methods for establishing femoral component rotation as a reference approach in total knee arthroplasty. The systematic review was planned and conducted in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. The review reports study characteristics, the number of patients dissatisfied with surgical outcomes, and the specific features of preoperative, intraoperative, and postoperative methods used to determine femoral component rotation in total knee arthroplasty. Initially, 354 articles meeting the main search criteria were identified. Overall, outcomes from 2132 total knee arthroplasties reported in the retrieved publications were analyzed. A total of 149 patients were dissatisfied with surgical outcomes because of anterior knee pain. As modern imaging technologies continue to advance rapidly, the use of more contemporary preoperative assessment methods is becoming increasingly relevant to improve clinical outcomes. Although visual and manual techniques may appear effective, they may be associated with a risk of femoral component malrotation exceeding 3°, which to some extent limits their use in clinical practice. The use of costly imaging modalities, such as computed tomography or magnetic resonance imaging, is not a standard procedure for postoperative screening assessment of implant position.