HOW DO I DETERMINE TIBIAL COMPONENT ROTATION IN TOTAL KNEE ARTHROPLASTY?

There are two fundamental goals to consider when discussing the optimal placement of the tibial component during total knee arthoplasty (TKA). My first goal is to prevent component subsidence by transmitting weight bearing forces to the largest possible surface area of bone. I prefer part of the load to be applied to the cortical rim of the proximal osteotomized tibia.^1-3 Optimal load transfer is achieved through a combination of component sizing and rotation. My second goal is to affect tibial-femoral and patella-femoral kinematics through the influence of tibial component rotation on the reconstruction Q-angle. 3 The importance of tibial component rotation on the reconstruction Q angle is often overstated. Femoral rotation is far more influential on the overall kinematics of a total knee replacement. The deleterious effects created by an improperly, internally rotated femoral component cannot be corrected by any amount of tibial rotation. ².