Femoral Component Malrotation in Total Knee Arthroplasty: Comparison of Gap Balancing and Measured Resection Technique – Randomized Controlled Trial

Background: Total knee arthroplasty (TKA) is a surgical procedure performed across the globe for managing late-stage knee osteoarthritis, with femoral component rotation playing a crucial role in long-term success.Malalignment can have multiple complications, including instability, patellar maltracking, and early prosthesis wear.This study aimed to analyze the effectiveness of the gap balancing (GB) technique and the measured resection (MR) technique in achieving optimal rotational alignment of the femur in TKA.Methods: A randomized controlled trial was conducted on 120 patients, with 60 allocated to the GB group and 60 to the MR group.Postoperative rotational alignment was evaluated using computed tomography (CT) imaging.The Oxford Knee Score (OKS) was used to assess the functional outcome of patients at 1 month, 3 months, 6 months, and at 1-year follow-up. Result:The GB technique overall resulted in an average femoral component rotation of 0.72° ± 0.4°, while the MR technique resulted in a much higher deviation (3.23° ± 0.9°) (p < 0.05).However, no statistically significant difference was observed in the functional scores when the two groups were compared (p = 0.08).Conclusion: These findings suggest that GB provides anatomical femoral rotational alignment, potentially reducing complications associated with rotational malalignment.While short-term functional outcomes were comparable between the techniques, further long-term studies are necessary to determine their impact on implant longevity, wear rates, and revision surgery incidence.The integration of robotic-assisted navigation may further enhance the precision of femoral component alignment.