N°011 - May / June 2021
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Myths and Facts on Components Rotational Alignment in Total Knee Arthroplasty
By Siegfried Hofmann(1), Oliver Djahani(1), Martin Pietsch(1), Gerd Seitlinger(2) in category UPDATE
(1) Orthopedic Hospital LKH Murtal-Stolzalpe, Austria - (2) Orthofocus, Guggenbichlerstrasse 20, 5026 Salzburg, Austria / [email protected]
Rotational alignment in Total Knee Arthroplasty (TKA) is the positioning of the components in the axial (transversal) plane, which represents the “third dimension” of the knee. TKA surgeons usually think in two planes (frontal and sagittal) only and the axial plane of the knee can be visualized with 3-D imaging modalities like CT, MRI or Sonography only. The clinical importance of the third dimension of the knee for TKA had been already recognized by J. Insall. He postulated that the components have to be aligned to the extensor mechanism otherwise the patella will not track properly . It is surprising that even after 40 years of TKA surgery there is no evidence and still controversy which might be the right rotational alignment for TKA components [2,3].
More than 25 years ago Rich Berger performed the first CT evaluation of a painful, not well functioning TKA which showed normal frontal and sagittal radiographs. Based on this experience he published the basics for the axial plane analysis for painful TKA using CT imaging technique . This was followed by the classical paper on the clinical relevance of malrotated components in TKA evaluated with his CT evaluation protocol  (Fig 1).
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