Knee Surg Sports Traumatol Arthrosc (2011) 19: 1131.

Femoral component rotation after balanced gap total knee replacement is not a predictor for postoperative patella position

Heesterbeek, P.J.C., Keijsers, N.L.W. & Wymenga, A.B.


Femoral component rotation is believed to be one of the factors influencing patellar tracking behavior. With the balanced gap implantation technique, the rotation of the femoral component can vary as it is guided by the ligaments. This study investigated whether femoral component rotation influenced patella position after primary total knee replacement (TKR).



In this prospective cohort study, a primary TKR was implanted in 49 patients using a balanced gap technique and a CT-free navigation system. Femoral component rotation was measured using the navigation data of the distal femur cut, referenced from the posterior condyles. At the 2-year follow-up, lateral patellar tilt and patellar displacement were measured on axial patella radiographs. Logistic regression analysis on femoral component rotation and preoperative patella position was conducted to identify predictors for postoperative patellar tilt and displacement.


Femoral component rotation that varied between −3 and 12° exorotation was not a predictor for postoperative tilt and displacement. Only preoperative displacement significantly predicted patella displacement.



Although the balanced gap implantation technique resulted in a wide inter-patient variability for femoral component rotation, this variable rotation was not found to be associated with abnormal patellar position. Preoperative displacement results in a higher risk at a postoperatively displaced patella. The balanced gap technique can safely be used without an elevated risk for patella malposition.


Level of evidence

Therapeutic studies, Prospective comparative study, Level II.

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