This JAAOS review by Sheth et al. compares the two dominant techniques for setting femoral component rotation in TKA — measured resection and gap balancing — and describes a hybrid approach. It addresses how each technique achieves implant alignment and soft-tissue balance, and under what patient conditions each is most appropriate.
When planning femoral rotation in TKA, use multiple landmark cross-checks (TEA, AP axis, posterior condylar axis) and confirm with a tensioned flexion gap — no single reference is reliable in isolation.
When you encounter trochlear dysplasia or an unreliable AP axis, default to gap balancing; when large posterior osteophytes or fixed ligamentous deformity are present, default to measured resection.
This JAAOS review by Sheth et al. compares the two dominant techniques for setting femoral component rotation in TKA — measured resection and gap balancing — and describes a hybrid approach. It addresses how each technique achieves implant alignment and soft-tissue balance, and under what patient conditions each is most appropriate.
When planning femoral rotation in TKA, use multiple landmark cross-checks (TEA, AP axis, posterior condylar axis) and confirm with a tensioned flexion gap — no single reference is reliable in isolation.
When you encounter trochlear dysplasia or an unreliable AP axis, default to gap balancing; when large posterior osteophytes or fixed ligamentous deformity are present, default to measured resection.