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Rotational alignment is important for a good functional outcome and the longterm success of total knee arthroplasty (TKA). Malalignment can cause patellofemoral complications such as subluxation, dislocation, and wear. Furthermore, abnormal internal or external rotational alignment is reportedly a cause of instability, implant loosening, and unexplained painful total knee arthroplasty. To determine the accurate rotational alignment for the femoral and tibial components, several studies have previously been conducted that discuss the advantages and disadvantages of various methodologies. Combining the knowledge from these multiple references and the various methodologies used could reduce component malrotation in TKA.