Background and Aims: Achieving proper axial rotational alignment of the femoral component for varus knees is a
critical step in total knee arthroplasty (TKA). Trans epicondylar axis (TEA) is the most reliable reference for alignment of
femoral component. Yet, nding the exact location is sometimes difcult and time consuming. The aim of this study was to determine the
correlation between the TEA and posterior condylar line reference (PCL) in varus knees. Besides, the other aim of this study was to nd the
relationship between lateral distal femoral angle (LDFA) and femoral component external rotation (ER) measured intraoperatively.
Material and Methods: This retrospective study was conducted on patients who were candidates for total knee arthroplasty from May 2016 to
December 2019. LDFA, VA were calculated based on hip-to-ankle (HTA) radiographs before the surgery. All patients underwent TKA through
an anterior midline incision. ER was calculated by determining TEA intraoperatively. All data were entered into SPSS software for data analysis.
Results: One hundred and four patients were included in the nal analysis. Nineteen patients (18.3%) were male and 85 out of 104 (81.7%) were
female. (P value = 0.001). No signicant relationship between the amount of ER measured during surgery and the amount of varus angle in varus
knees was observed. Furthermore, there were no correlations between ER and LDFA in varus knees.
Conclusion: Adjusting femoral component in 3 degrees external rotation relative to posterior condylar line reference achieves proper rotational
alignment of the femoral component in the axial plane in varus knees. Also, the lateral distal femoral angle measured preoperatively from knee
radiographs is not a predictor of ER in varus knees