Landmarks for optimizing component position in total knee arthroplasty

Purpose of review The aim of this article is to review the principles of alignment in total knee arthroplasty and the surgical landmarks available for optimizing component position, and to summarize and interpret recently published data on these subjects to aid the orthopedic surgeon in utilizing best practices based on current evidence. Recent findings One focus of recent investigations in total knee arthroplasty has been a critical appraisal of surgical landmarks used to determine prosthetic alignment, with the aim of achieving more reproducible results with standard instruments. A second focus has been a comparison of computer navigation systems to traditional guides and jigs. With regard to coronal and sagittal alignment, navigation has decreased the frequency of 'outliers', whereas improvement in rotational alignment has not been consistently demonstrated. Navigation has not been shown to improve clinical outcomes in the short term. The cost, learning curve, and increased surgical times currently associated with navigation continue to limit its widespread adoption. Summary The principles of alignment in total knee arthroplasty remain unchanged. Proper alignment can be reproducibly achieved by recognition of specific anatomic landmarks and proper use of traditional instrumentation; new data suggest, however, that navigation may help surgeons to minimize the risk of coronal malalignment.