Volume 4, Issue 1, Pages (March 2018)

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Volume 4, Issue 1, Pages 78-84 (March 2018) A computer-assisted, tibia-first technique for improved femoral component rotation in total knee arthroplasty Chong Meng Lee, FRCS (Ed), Malkit K. Dhillon, MMed Radiology (UKM), Mohd Amin Sulaiman, Dip Radiography (UM) Arthroplasty Today Volume 4, Issue 1, Pages 78-84 (March 2018) DOI: 10.1016/j.artd.2017.06.007 Copyright © 2017 The Authors Terms and Conditions

Figure 1 Proximal tibial resection performed and verified using navigation. Arthroplasty Today 2018 4, 78-84DOI: (10.1016/j.artd.2017.06.007) Copyright © 2017 The Authors Terms and Conditions

Figure 2 Distal femoral resection performed and verified using navigation. Arthroplasty Today 2018 4, 78-84DOI: (10.1016/j.artd.2017.06.007) Copyright © 2017 The Authors Terms and Conditions

Figure 3 A custom spacer with a navigation tracker attached was inserted with the knee in 90° flexion (upper image). The inferior surface of the spacer was flush with the resected tibia and the posterior femoral condyles are resting on the superior surface of the spacer. The navigation step “align femoral rotation” dialog was used to determine the magnitude of internal/external rotation, as displayed on the navigation display (lower image). Arthroplasty Today 2018 4, 78-84DOI: (10.1016/j.artd.2017.06.007) Copyright © 2017 The Authors Terms and Conditions

Figure 4 Femoral preparation was performed using a 4-in-1 cutting jig. The magnitude of the femoral internal/external rotation determined in the previous step (ie, 11.5°) was used to align the cutting jig. This allowed for the femoral component to be positioned parallel to the proximal tibial resection plane. Arthroplasty Today 2018 4, 78-84DOI: (10.1016/j.artd.2017.06.007) Copyright © 2017 The Authors Terms and Conditions

Figure 5 Sample of long-leg standing radiographic image of the patient with bilateral TKA. Landmarks and axes were defined according to the method of Shi et al [18]. Arthroplasty Today 2018 4, 78-84DOI: (10.1016/j.artd.2017.06.007) Copyright © 2017 The Authors Terms and Conditions

Figure 6 Sample of 3-dimensional CT scan reconstruction to confirm location of tibial tuberosity and center of tibia (blue arrow). Arthroplasty Today 2018 4, 78-84DOI: (10.1016/j.artd.2017.06.007) Copyright © 2017 The Authors Terms and Conditions

Figure 7 Measurement of femoral rotation with CT scan. A-A indicates surgical TEA. Arthroplasty Today 2018 4, 78-84DOI: (10.1016/j.artd.2017.06.007) Copyright © 2017 The Authors Terms and Conditions