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A net lateral patellar tilt and increased lateral subluxation
92%
5643/6132
A decreased Q angle
4%
229/6132
Patella baja
0%
29/6132
A loose medial compartment and tight lateral compartment
3%
184/6132
Balanced medial and lateral flexion gaps
27/6132
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Internal rotation of the femoral component results in lateral patellar tracking/tilt, and can increase lateral patellar subluxation due to an increase in the Q angle. Olcott et al performed 100 consecutive CR-TKA's to determine the most appropriate method for femoral alignment necessary to create a rectangular flexion gap. The transepicondylar axis was most accurate in creating a balanced flexion space, however taking 3 degrees external rotation off the posterior condyles was least consistent especially in knees in valgus. Heesterbeek et al performed the balanced gap technique on 83 TKA's and found no difference in femoral component rotation of knees with or without ligament releases in extension. They also concluded that preoperative alignment had no influence on femoral component rotation. Incorrect answers: 2: Internal rotation increases the Q angle. 3: Patella baja occurs when the joint line is raised, and causes a loss of knee flexion. 4: Internal rotation of the femoral component can lead to a tight medial compartment, and loose lateral compartment with the knee in flexion. (Illustration B) 5: Because the tibia is cut perpendicular to its mechanical axis, the femoral component should be externally rotated to create a rectangular flexion gap. (Illustration A)
4.2
(22)
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