Total knee arthroplasty in last years has changing the field of applications: from old patients with low demand activities is shifting toward younger patients with higher level of activities demand.

Details are promising to more reliable outcomes. Surgeons in conjunction with orthopaedic industries are studying a new instrumentation to better fit the anatomy in M.I.S. surgery and more precise design able to reproduce the correct tensioning of ligaments. In the years, two philosophies were developing to the assess femoral rotation in total knee arthroplasty: bone references and ligament references.

The first one use the bone landmarks to assess the right femoral rotation while the second one use the ligament tensioning to assess the femoral rotation.

Both technique and instruments are able to attend good outcomes, further anatomic and biomechanical studies seem to show that the difference between the two surgical approach can be avoided. Instead of developing a new class of instruments, we put together the two philosophies giving to the surgeon more challenge to assess the femoral rotation in total knee arthroplasty. This study shows the early results with FBI instrumentation (Zimmer ins, Warsaw). We operated 24 patients using FBI instrumentation. The case load included 16 men and 8 women. The age distribution was from 63 to 75 years with a median age of 68. The operation time has been the same one of the traditional instrumentation.

So far the patients have been shown good and improved early recovery. There was not any complication during the early post-operative time.

This is use a mini soft tissue tenser good to fit in MIS surgery and a IM rod for the free femoral rotation, at same time surgeon can check the femoral landmarks (Whiteside line and epi-line) to put the two ways in conjunction and fitting better outcomes.