TKA Patellofemoral Alignment

• Abnormal tracking is most common complication

• Goal is to maintain Q angle (11 +/- 7)
Patellofemoral alignment
• Femoral component Referencing (Rectangular flexion gap)
• AP axis
• Line from center of the trochlear groove to top of intercondylar notch
• A line perpendicular to this will be neutral rotational axis

• Transepicondylar axis
• Line running from medial to lateral epicondyle
• Parallel to tibial cut surface
• Posterior femoral cut parallel to this will create rectangular flexion gap
Femoral component Alignment
• Femoral component referencing

• Posterior condylar axis

• Line running across the tips of two posterior condyles
• It is in 3 deg int rotation from transepicondylar axis
• Femoral component should be externally rotated 3
degrees
• Can become tricky in valgus deformities
Tibial component alignment/positioning
• Preferred rotation is neutral
• Centered over the medial third of tibial tubercle
• Can cause overhang on posterolateral side and uncovered bone on
posteromedial side
• Avoid internal rotation
• Avoid medialization
Patellar component positioning
• Preferred position is center to medial
• Medial position risks lateral facet syndrome
• Can consider using patella with medialized apex
• Resurfacing is optional with merits and demerits
• Absolute indications
• Inflammatory arthritis
• Patella maltracking
• Patellofemoral arthritis
Further reading…
• Indications for TKR
• Pre-op prep
• Approaches
• Post op complications
• Revision surgery