Total Hip Arthroplasty (THA) MCQs

To optimize stability and minimize impingement in THA, the concept of combined anteversion is often utilized. If the acetabular cup is placed in 15 degrees of anteversion, what is the ideal target for femoral stem anteversion to achieve a standard combined anteversion of 35-40 degrees?

Which of the following surgical factors is most strongly associated with the postoperative complication of 'squeaking' in a ceramic-on-ceramic total hip arthroplasty?

A 62-year-old male presents with new-onset cardiomyopathy, peripheral neuropathy, and visual field changes 6 years after a revision total hip arthroplasty. Aspiration of the hip yields clear fluid with a low white blood cell count. Which of the following implant configurations is most likely responsible for his systemic symptoms?

A 55-year-old male undergoes a primary THA via a direct anterior approach. Postoperatively, he notes a burning pain and numbness isolated to the anterolateral aspect of his operative thigh. Strength is fully intact. Injury to which nerve is the most likely cause?

A 76-year-old female presents with a third episode of posterior dislocation following a primary THA. Radiographs show well-fixed, correctly positioned components. Intraoperatively, her abductor musculature is found to be completely avulsed, retracted, and irreparable. Which of the following is the most appropriate definitive management?

A 68-year-old female presents with progressive groin pain 6 years after a metal-on-polyethylene THA utilizing a modular titanium stem and cobalt-chrome head. Aspiration yields fluid with 2,500 WBC/uL (80% lymphocytes) and negative cultures. Serum cobalt is markedly elevated. What is the most appropriate definitive management?

A 45-year-old active male underwent a primary THA. Two years postoperatively, he complains of an audible squeaking noise with walking and bending, but denies pain. Radiographs show well-fixed, well-positioned components. Which bearing surface combination is most classically associated with this complication?

During preoperative templating for a total hip arthroplasty, the surgeon notes a 15 mm functional leg length discrepancy (affected side short) and a 10 mm anatomic true leg length discrepancy (affected side short). To avoid symptomatic over-lengthening postoperatively, the surgeon should aim to restore:

A 74-year-old female presents for revision THA. Radiographs demonstrate an inferiorly migrated acetabular component, a transverse radiolucent line across the posterior column, and an ilioischial line break. Intraoperatively, the superior and inferior hemi-pelves move independently. Which of the following is the most appropriate reconstructive technique?

A 68-year-old female presents with recurrent episodes of anterior hip dislocation following a primary total hip arthroplasty. Her dislocations typically occur when she extends and externally rotates her hip while walking. Which of the following component malpositions is the most likely cause of this specific instability pattern?

A 65-year-old female undergoes primary total hip arthroplasty (THA) via a posterior approach. Post-operatively, she experiences recurrent anterior dislocations.

Which of the following component malpositions is the most likely cause of her anterior instability?

A 65-year-old male is 3 months post-operative from a primary total hip arthroplasty (THA) via a posterior approach. He presents with a history of three posterior dislocations. Radiographs demonstrate a well-fixed acetabular component with 45 degrees of abduction and 20 degrees of anteversion. The femoral stem is stable but appears retroverted by 10 degrees. What is the most appropriate surgical intervention to definitively address this instability?

In ceramic-on-ceramic total hip arthroplasty, which of the following component malpositions is most strongly associated with the complication of squeaking?

A 45-year-old male with a ceramic-on-ceramic total hip arthroplasty presents 3 years postoperatively complaining of a loud squeaking noise with walking. Radiographs demonstrate well-fixed components. Which of the following factors is most strongly associated with the etiology of this phenomenon?

A patient undergoes a primary total hip arthroplasty (THA) via a posterior approach. Six weeks postoperatively, the patient sustains a posterior dislocation while sitting in a low chair. Which combination of component malpositioning most commonly predisposes to this specific pattern of instability?

When comparing the direct anterior approach (DAA) to the posterior approach for primary total hip arthroplasty, which of the following complications has a definitively higher incidence in the DAA cohort based on recent large registry and meta-analysis data?

During the posterior approach to the hip (Kocher-Langenbeck), preservation of the blood supply to the femoral head is a critical consideration if the femoral head is to be retained. The deep branch of the medial femoral circumflex artery (MFCA) is protected primarily by which of the following intact structures?

A patient experiences recurrent posterior dislocations following a primary total hip arthroplasty. Radiographs and a CT scan demonstrate the acetabular component is well-fixed but placed in 5 degrees of retroversion. Which of the following is the most appropriate definitive management?

Which factor is most highly associated with the clinical phenomenon of 'squeaking' in a ceramic-on-ceramic total hip arthroplasty?