Total Knee Arthroplasty (TKA) MCQs

Intraoperatively during a primary TKA, the surgeon utilizes spacer blocks and finds that the flexion gap is excessively tight, but the extension gap is perfectly symmetric and balanced. Which of the following is the most appropriate surgical step to correct this kinematic mismatch?

Elevation of the joint line during TKA (often resulting from excessive distal femoral resection and using a thicker polyethylene insert) most commonly leads to which of the following complications?

Following a complete disruption of the extensor mechanism after TKA, a reconstruction utilizing synthetic mesh (e.g., Marlex) is performed. What is the critical recommended postoperative rehabilitation protocol to ensure construct survival?

A 72-year-old patient undergoes a primary TKA for severe valgus deformity. Intraoperatively, the medial collateral ligament (MCL) is found to be severely attenuated and incompetent, preventing varus-valgus stability with standard gap balancing, but the extensor mechanism and soft tissue envelope are otherwise intact. Which level of implant constraint is most appropriate as the next step?

A patient presents 8 weeks after a primary TKA with severe stiffness. Despite aggressive, supervised physical therapy, their active and passive range of motion is limited to a painful arc from 15 degrees of extension to 75 degrees of flexion. What is the most appropriate next step in management?

A 70-year-old female presents with a feeling of instability when going down stairs one year after a primary TKA. Clinical exam reveals stability in full extension and at 90 degrees of flexion, but excessive AP laxity at 30-45 degrees of flexion. Which of the following technical errors is the most likely cause?

During TKA, joint line restoration is critical for proper biomechanics. Which of the following is a direct consequence of inadvertently elevating the joint line by more than 8 mm?

Patellar maltracking is a significant complication following TKA. Which of the following component malpositions is most likely to cause lateral patellar maltracking?

A patient with a severe 20-degree valgus knee deformity undergoes a primary posterior-stabilized TKA. On post-operative day 1, the patient exhibits a new-onset foot drop and numbness over the first dorsal web space. What is the most appropriate initial step in management?

During a primary TKA trial reduction, the surgeon notes that the joint is symmetrically loose in full extension and symmetrically loose in 90 degrees of flexion. Which of the following is the most appropriate single intervention?

A 68-year-old female presents with the inability to perform a straight leg raise 6 months following a primary TKA. Radiographs demonstrate a displaced patellar fracture with severe disruption of the extensor mechanism.

Assuming poor host tissue quality and inadequate remnant tissue for direct repair, what is the most reliable reconstructive option for a chronic, severe extensor mechanism disruption post-TKA?

A 70-year-old male undergoes a posterior-stabilized (PS) TKA. Postoperatively, he experiences a catching sensation and palpable clunk as the knee actively extends from 40 degrees of flexion. Which design factor is most strongly associated with this complication?

During a primary TKA for severe varus deformity, the medial compartment remains tight in both flexion and extension after resection of osteophytes and deep medial collateral ligament release. Which of the following structures should be released next to achieve coronal balance?

A 75-year-old female with severe rheumatoid arthritis presents for a primary total knee arthroplasty. Clinical and radiographic evaluation demonstrates a severe valgus deformity with a completely incompetent, non-functional medial collateral ligament (MCL). Which of the following implant constraints is indicated?

Which of the following best describes the primary goal of the kinematic alignment philosophy in total knee arthroplasty compared to traditional mechanical alignment?

A 65-year-old male complains of knee instability when descending stairs 1 year after a primary TKA. Examination reveals a knee that is fully stable in full extension but exhibits marked anteroposterior laxity in 90 degrees of flexion. Which of the following intraoperative technical errors most likely occurred?

During a primary TKA for a fixed valgus deformity of 20 degrees, the surgeon notes a tight lateral compartment in full extension, but the knee is well-balanced in 90 degrees of flexion. Which of the following structures is the primary tether and should be released to balance the gaps?

During a primary TKA, the surgeon uses spacer blocks to assess gap kinematics. The extension gap is symmetric and well-balanced. However, the flexion gap is symmetric but significantly tight, preventing adequate knee flexion with the trial components. Which of the following technical adjustments is the most appropriate next step to balance the knee?

During a complex primary TKA for a severe fixed valgus deformity, the medial collateral ligament (MCL) is inadvertently transected mid-substance and is deemed completely incompetent and irreparable. Which of the following implant constraints is required to provide adequate stability?

A 66-year-old patient undergoes revision TKA. The surgeon utilizes thick tibial and femoral augments to manage bone loss. Postoperatively, the patient reports a painful catch and mid-flexion instability. Lateral radiographs show the inferior pole of the patella is abnormally close to the tibial plateau. What intraoperative technical error most likely led to this complication?