FEMORAL COMPONENT SIZING DURING TOTAL KNEE ARTHROPLASTY Anterior Versus Posterior Referencing

Distal femoral preparation and sizing are important for overall balancing and function. Femoral sizing and subsequent osseous resections can be performed with use of either an anterior or a posterior referencing technique. With the anterior referencing technique (that is, referencing the anterior and posterior femoral resection on the basis of the anterior femoral cortex), notching of the anterior femoral cortex can be avoided, but it is more difficult to control posterior condylar offset and the size of the flexion gap. With the posterior referencing technique (that is, referencing on the basis of the posterior condyles), the size of the flexion gap and posterior condylar offset usually can be controlled, but the risk of anterior notching or overstuffing is increased. To our knowledge, there have been no high-level studies showing a difference in outcomes between the 2 techniques.