Total Hip Arthroplasty (THA) MCQs

A posterior approach to the hip is performed. To protect the main blood supply to the adult femoral head, careful handling of which vessel is required, and where does it course?

When performing a posterior approach to the knee, the tibial nerve is identified in the popliteal fossa. Which of the following correctly describes its position relative to the popliteal artery and vein?

The deep branch of the medial femoral circumflex artery (MFCA) provides the primary blood supply to the femoral head. Prior to piercing the hip capsule, it courses posteriorly between which two muscles?

The direct lateral (Hardinge) approach to the hip involves splitting the gluteus medius. To avoid denervating the anterior portion of the gluteus medius, the proximal split should not extend beyond what distance from the tip of the greater trochanter?

To preserve the primary blood supply to the adult femoral head during a posterior approach to the hip, which of the following structures must be carefully protected as it defines the upper limit of the deep dissection?

During a posterior approach to the knee, the surgeon dissects through the popliteal fossa. From superficial to deep (posterior to anterior), what is the correct order of the major neurovascular structures encountered?

A 4-year-old boy sustains a nondisplaced proximal tibial metaphyseal fracture that is treated successfully in a long leg cast for 4 weeks. One year later, the parents bring him to the clinic concerned about a deformity in the injured leg. What is the most likely deformity and its anticipated natural history?

A 48-year-old active man complains of a loud, high-pitched squeaking noise coming from his right hip, particularly when bending to tie his shoes. He underwent an uncomplicated ceramic-on-ceramic total hip arthroplasty 2 years ago. Radiographs demonstrate a well-fixed stem and a cup with 65 degrees of inclination. What is the most likely cause of this phenomenon?

A 45-year-old active man presents with a high-pitched squeaking noise from his hip 3 years after a cementless primary THA with a ceramic-on-ceramic bearing. The noise occurs primarily during deep flexion activities. Which of the following component positional factors most strongly correlates with this phenomenon?

An 81-year-old man falls and sustains a periprosthetic femur fracture around his cemented THA.

Radiographs reveal a fracture occurring around a loose femoral stem, but with adequate surrounding proximal bone stock. What is the most appropriate surgical treatment?

During trialing in a primary THA via a posterior approach, the surgeon notes the leg lengths are perfectly equal to the contralateral side, but the hip easily dislocates in adduction and internal rotation. To increase stability via soft tissue tensioning without altering the leg length, which of the following component changes should be made?

A 70-year-old man undergoes revision THA for recurrent posterior dislocations. During the procedure, the surgeon notes that the existing acetabular component is in neutral version. To minimize future posterior instability, the surgeon should reposition the cup to achieve which target orientation?

A 60-year-old woman complains of new-onset, sharp groin pain with active hip flexion, such as getting into a car, 6 months after an uncomplicated THA. Radiographs show the acetabular cup is retroverted and prominent anteriorly. What is the most appropriate initial management?

When converting a standard offset femoral stem to a high offset femoral stem of the exact same neck angle during total hip arthroplasty, what is the expected biomechanical effect on the hip joint?

During preoperative templating for a primary THA, the surgeon identifies a significant leg length discrepancy, with the operative side being 2 cm shorter. To lengthen the leg without excessively increasing the femoral offset, which intraoperative adjustment should be made?

A 45-year-old man undergoes total hip arthroplasty using a ceramic-on-ceramic bearing. Three years later, he complains of a reproducible squeaking noise during deep flexion. Which of the following biomechanical factors is most strongly associated with this phenomenon?

During preoperative templating for a total hip arthroplasty, the surgeon plans to use a high-offset femoral stem. Compared to a standard-offset stem, what is the primary biomechanical advantage of increasing femoral offset?

Following a primary THA using a posterior approach, a patient exhibits foot drop and an inability to actively dorsiflex the ankle. Eversion of the foot is also weak, but ankle inversion is normal. Which branch of the sciatic nerve is most likely injured, and what is its most common mechanism of injury?

A 68-year-old woman experiences her third posterior dislocation of her THA within 6 months. Radiographs demonstrate a well-fixed acetabular component with 55 degrees of abduction and 0 degrees of anteversion. The femoral stem is well-fixed with 15 degrees of anteversion. What is the most appropriate surgical intervention?

A patient has recurrent posterior dislocations post-THA. Radiographs demonstrate that the acetabular component is retroverted, while the femoral stem is well-fixed with normal anteversion. What is the best definitive treatment?