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3 There Is an Optimal Rotational Alignment in Total Knee Replacement: Femoral Rotation Does Matter!

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The Unhappy Total Knee Replacement

Abstract

Malrotation of the femoral and/or tibial TKR component leads to an asymmetric, unbalanced flexion gap, instability in flexion or stiffness, anterior knee pain, or patellar maltracking. Typically patients have pain when climbing stairs or complain about a limited range of motion. Optimal rotational alignment remains an important challenge, and several techniques have been described for determining the femoral rotational alignment in TKR. There is no single reference axis or surgical technique which should be used in every single patient. Most instruments use the posterior femoral condyles as a standard; therefore, the surgical transepicondylar axis and the anteroposterior trochlear line can be used to verify femoral rotation. Surgeons, who prefer the flexion gap balanced technique, may also need to use these bony landmarks to verify femoral rotation. The extension gap first technique combines the bony landmarks with the flexion gap balanced technique to identify femoral rotational alignment.

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Authors and Affiliations

  1. Orthopedic Hospital Stolzalpe, LKH Stolzalpe, Stolzalpe, 8852, Austria

    Martin Pietsch MD, Oliver Djahani MD & Siegfried Hofmann MD, PhD

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  1. Martin Pietsch MD
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  2. Oliver Djahani MD
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  3. Siegfried Hofmann MD, PhD
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Correspondence to Martin Pietsch MD .

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Editors and Affiliations

  1. Dept. Orthopaedic Surgery & Traumatology, Knee Surgery Unit, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland

    Michael T. Hirschmann

  2. Dept. Orthopaedics & Traumatology, Hospital Brandenburg, Brandenburg/Havel, Germany

    Roland Becker

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Pietsch, M., Djahani, O., Hofmann, S. (2015). 3 There Is an Optimal Rotational Alignment in Total Knee Replacement: Femoral Rotation Does Matter!. In: Hirschmann, M., Becker, R. (eds) The Unhappy Total Knee Replacement. Springer, Cham. https://doi.org/10.1007/978-3-319-08099-4_3

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  • DOI: https://doi.org/10.1007/978-3-319-08099-4_3

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-08098-7

  • Online ISBN: 978-3-319-08099-4

  • eBook Packages: MedicineMedicine (R0)

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