Rotational alignment in total knee arthroplasty

Total knee arthroplasty is a successful procedure for end-stage knee osteoarthritis, demonstrating a 10-year survival rate of 92–98%. Rotational alignment of components affects the kinematics of the tibiofemoral and patellofemoral joints and the longevity of the implant. Reliable references for rotation for the femoral component are the transepicondylar axis and the Whiteside line (AP Axis), while a reliable reference for tibial baseplate rotation is the tibial tubercle. Assessing rotation postoperatively requires a CT scan. Revision for malrotation has proven to be successful for isolated component or combined component malrotation, yielding improvements in range of motion and Knee Society Scores.