© 2017, Springer-Verlag GmbH Germany, part of Springer Nature.Purpose: To investigate the appropriate mediolateral placement of symmetrical tibial components and the amount of overhang expected from the posterolateral of tibial components implanted to give ideal coverage and the subsequent incidence of residual knee pain and reduction in functional capacity. Method: A retrospective evaluation was made of 146 consecutive total knee arthroplasties. The posterolateral overhang, rotational alignment and coverage of the tibial component were measured on a post-operative CT scan and the effect of posterolateral overhang on clinical outcomes was analysed 3 years after surgery. Results: Complaints of local pain in the posterolateral corner were determined in 76 (52.1%) patients. At the Posterolateral corner, overhang was determined in 111 (76%) patients, in the cortical border in 11 (7.6%) patients and underhang in 24 (16.4%) patients. In 71 (48.6%) patients, pain was determined together with oversize and in the evaluation of the overhang of the tibial component in the posterolateral region and the rotation status, there was determined to be overhang in 75 (96.2%) patients where the tibial component was placed in ideal rotation, in 25 (100%) where placement was in external rotation and in 11 (25.6%) where placement was in internal rotation. The mean KSS, KSS-F and WOMAC-P scores were 83.9 ± 6.3, 83.3 ± 7.8 and 4.6 ± 2.9, respectively, in those with posterolateral overhang of the tibial component.The mean KSS, KSS-F and WOMAC-P scores were 86.6 ± 8.4, 89.5 ± 7.8 and 2.8 ± 2.1, respectively, in those with no overhang and the difference was determined to be statistically significant. The amount of overhang was determined as mean 3.6 ± 2.0 mm in those with posterolateral pain and 0.02 ± 3.4 mm in those without pain and the difference was statistically significant. Conclusions: This study demonstrated that overhang in the posterolateral region is surprisingly high and negatively affects the clinical results following TKA, thereby presenting a danger to the success of TKA. The risk of posterolateral oversizing can increase with placement of the tibial component in external rotation.