Total Hip Arthroplasty (THA) MCQs

A 45-year-old female presents with persistent anterior groin pain 14 months after a primary THA. The pain is exacerbated when actively lifting her leg into a vehicle. Radiographs show the acetabular component in 15 degrees of anteversion with no signs of loosening, but a cross-table lateral view demonstrates the anterior edge of the cup is completely flush with the anterior acetabular rim. After 6 months of failed physical therapy and corticosteroid injections, what is the best surgical intervention?

A 55-year-old active male underwent a THA with a ceramic-on-ceramic bearing surface. Two years later, he reports an audible squeaking sound during hip flexion, but denies pain. What is the most significant risk factor for this phenomenon?

During a total hip arthroplasty, the surgeon decides to use a high-offset femoral stem instead of a standard-offset stem to optimize abductor mechanics. Assuming the leg length remains completely unchanged, what is the biomechanical effect of this decision?

A 69-year-old female experiences recurrent posterior dislocations after a primary total hip arthroplasty performed through a posterior approach. Radiographic evaluation reveals the acetabular component is positioned in 30 degrees of abduction and 5 degrees of retroversion.

What is the most definitive surgical treatment to prevent future dislocations?

A 72-year-old woman presents with recurrent posterior dislocations following a primary total hip arthroplasty (THA) performed via a posterior approach. She has had three dislocations in the past 4 months. Radiographs demonstrate appropriate component positioning with an acetabular cup anteversion of 15 degrees and abduction of 40 degrees. The femoral stem is stable and in 15 degrees of anteversion. Which of the following is the most appropriate surgical option to minimize the risk of future dislocations?

A 62-year-old man undergoes primary total hip arthroplasty via a direct anterior approach. Intraoperatively, after placing the trial components, the leg lengths are perfectly equal compared to the contralateral side; however, the hip is unstable in extension and external rotation, tending to anteriorly dislocate. Which of the following component changes would most appropriately improve stability without increasing the patient's leg length?

A 55-year-old active man underwent THA with a ceramic-on-ceramic bearing surface. Three years postoperatively, he complains of an audible squeaking sound from his hip during ambulation, though he denies any pain. Radiographs show well-fixed components with the acetabular cup placed in 65 degrees of inclination and 35 degrees of anteversion. What is the most likely underlying cause of the squeaking?

A 72-year-old woman experiences her third posterior dislocation 2 months after a primary total hip arthroplasty via a posterior approach. Radiographs reveal the acetabular component is placed in 45 degrees of abduction and 5 degrees of retroversion. The femoral stem is anteverted 15 degrees. What is the most appropriate definitive management?

A 70-year-old woman experiences multiple posterior dislocations following a primary THA via a posterior approach. A CT scan shows the acetabular component is in 5 degrees of anteversion and 40 degrees of inclination. The stem is in 15 degrees of anteversion. What is the most appropriate definitive management?

Following a primary THA via a direct anterior approach, a patient complains of numbness and burning pain over the anterolateral thigh. Which of the following intraoperative maneuvers most likely caused this complication?

During a posterolateral approach THA, which intraoperative landmark is most reliable for assessing leg length and offset changes prior to final component implantation?

A 45-year-old woman complains of groin pain 6 months after an uncomplicated direct anterior approach THA. Pain is reproducible with active straight leg raise and resisted hip flexion. Radiographs demonstrate a neutral acetabular component with 8 mm of anterior overhang over the bony rim. Initial management should consist of?

A 55-year-old woman complains of an audible squeaking sound from her ceramic-on-ceramic total hip arthroplasty while walking. Which of the following factors is most strongly associated with this phenomenon?

The direct anterior approach (DAA) for total hip arthroplasty has gained popularity due to its use of a true internervous and intermuscular plane. When compared to the posterior approach, the DAA is associated with a higher incidence of which of the following complications?

An 80-year-old woman falls and sustains a periprosthetic femur fracture 10 years after a cemented THA. Radiographs show a transverse fracture around the tip of the stem. The stem demonstrates significant subsidence, and the cement mantle is fractured, but the proximal femoral bone stock remains robust. What is the most appropriate surgical management?

A 55-year-old woman undergoes a cementless total hip arthroplasty (THA) with a ceramic-on-ceramic bearing. One year postoperatively, she complains of an audible 'squeaking' sound with walking, though she is otherwise pain-free. Which of the following factors is most strongly associated with the development of squeaking in ceramic-on-ceramic THA?

During a primary total hip arthroplasty, the surgeon opts to use a high-offset femoral stem, effectively increasing the femoral offset by 10 mm compared to the patient's native anatomy, while maintaining equal leg lengths. What is the primary biomechanical effect of this increase in femoral offset?

A 62-year-old woman is evaluated for persistent hip pain 8 years after receiving a metal-on-metal total hip arthroplasty. Radiographs reveal an acetabular inclination angle of 58 degrees. Laboratory testing demonstrates significantly elevated serum cobalt and chromium levels. Which of the following systemic conditions is a known, severe manifestation of cobalt toxicity (cobaltism) stemming from a failing metal-on-metal implant?

A 45-year-old active male undergoes a primary total hip arthroplasty (THA). A ceramic-on-ceramic bearing is chosen. At 2-year follow-up, he complains of a squeaking noise from his hip during deep bending and walking. What is the most significant surgeon-controlled risk factor for this complication?

During preoperative templating for a total hip arthroplasty, the surgeon plans to increase the femoral offset by 10 mm compared to the contralateral normal hip, without changing the leg length. What is an expected biomechanical consequence of this planned alteration?