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3. Adult Reconstruction (Hip & Knee) MCQs

Practice Set 1 of 326

This practice set contains high-yield board review questions covering key concepts in 3. Adult Reconstruction (Hip & Knee). Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 1

Topic: 3. Adult Reconstruction (Hip & Knee)

Proximal humeral anatomy is variable. Which of the following measurements most accurately describe the range of diameters of the humeral head (length of line AB):

. 25 mm to 35 mm
. 35 mm to 45 mm
. 45 mm to 55 mm
. 25 mm to 45 mm
. 35 mm to 55 mm

Correct Answer & Explanation

. 35 mm to 55 mm

Explanation

Proximal humeral anatomy is variable. The high variability is the basis for radical changes in design of shoulder arthroplasty. The diameter of the humeral head ranges from approximately 35 mm to 55 mm.

Question 2

Topic: 3. Adult Reconstruction (Hip & Knee)

Proximal humeral anatomy is variable. Which of the following measurements most accurately describe the range of radius of curvature of the humeral head (length of line AB):

. 5 mm to 10 mm
. 10 mm to 15 mm
. 15 mm to 20 mm
. 20 mm to 30 mm
. 30 mm to 40 mm

Correct Answer & Explanation

. 20 mm to 30 mm

Explanation

Proximal humeral anatomy is variable. This high variability is the basis for radical changes in design of shoulder arthroplasty. The humeral head radius of curvature ranges from approximately 20 mm to 30 mm.

Question 3

Topic: 3. Adult Reconstruction (Hip & Knee)

What is a common complication of total hip arthroplasty?

. Increased bone density
. Dislocation
. Hyperglycemia
. Enhanced lymphatic flow
. Reduced muscle atrophy

Correct Answer & Explanation

. Dislocation

Explanation

Dislocation is a known complication of total hip arthroplasty, particularly in the early postoperative period. Careful patient education and surgical technique are crucial to minimize this risk.

Question 4

Topic: 3. Adult Reconstruction (Hip & Knee)

What is the most appropriate initial treatment for a displaced femoral neck fracture in an elderly patient?

. Non-operative management with traction
. Hemiarthroplasty or total hip arthroplasty
. Internal fixation with screws
. External fixation
. Hip spica cast

Correct Answer & Explanation

. Hemiarthroplasty or total hip arthroplasty

Explanation

In elderly patients with displaced femoral neck fractures, the risk of avascular necrosis and non-union is high with internal fixation, making arthroplasty (hemiarthroplasty or total hip arthroplasty) the preferred treatment.

Question 5

Topic: 3. Adult Reconstruction (Hip & Knee)

Which surgical approach for total hip arthroplasty is known for having a lower risk of dislocation but potentially higher risk of nerve injury?

. Anterior approach
. Posterior approach
. Lateral approach
. Anterolateral approach
. Transtrochanteric approach

Correct Answer & Explanation

. Anterior approach

Explanation

The direct anterior approach often involves working between muscle planes, theoretically reducing dislocation risk. However, it can put the lateral femoral cutaneous nerve (LFCN) at higher risk of injury, leading to meralgia paresthetica.

Question 6

Topic: 3. Adult Reconstruction (Hip & Knee)

What is the most effective long-term treatment for osteoarthritis?

. NSAIDs only
. Joint replacement (arthroplasty)
. Corticosteroid injections
. Physical therapy alone
. Chondroitin and glucosamine supplements

Correct Answer & Explanation

. Joint replacement (arthroplasty)

Explanation

While conservative treatments can manage symptoms, joint replacement (arthroplasty) is the most effective long-term treatment for severe, end-stage osteoarthritis, providing significant pain relief and improved function.

Question 7

Topic: Total Hip Arthroplasty (THA)

A 25-year-old athlete sustains an acute traumatic knee dislocation. In the emergency department, the Ankle-Brachial Index (ABI) is measured at 0.8. A CTA confirms a popliteal artery intimal tear. The vascular surgeon repairs the artery via a posterior approach. What is the most appropriate next orthopedic step?

. Immediate multiligament anatomical reconstruction
. Application of a spanning external fixator
. Application of a hinged knee brace locked in 30 degrees of flexion
. Cylinder cast application and early weight-bearing
. Delayed primary repair of the cruciate ligaments only

Correct Answer & Explanation

. Application of a spanning external fixator

Explanation

Following a vascular repair in the setting of a knee dislocation, a spanning external fixator is recommended to provide absolute skeletal stability and protect the delicate vascular anastomosis.

Question 8

Topic: Total Knee Arthroplasty (TKA)

A medial meniscus posterior root tear is most strongly associated with which of the following secondary knee pathologies on MRI?

. Anterior cruciate ligament rupture
. Meniscal extrusion greater than 3 mm
. Patellar tendinopathy
. Segond fracture
. Iliotibial band friction syndrome

Correct Answer & Explanation

. Meniscal extrusion greater than 3 mm

Explanation

Medial meniscus posterior root tears result in the loss of hoop stresses, which is functionally equivalent to a total meniscectomy. This biomechanical failure commonly leads to meniscal extrusion of >3 mm and rapid progression of unicompartmental osteoarthritis.

Question 9

Topic: 3. Adult Reconstruction (Hip & Knee)

A 55-year-old female presents with chronic lateral hip pain, refractory to extensive physical therapy and multiple corticosteroid injections. MRI demonstrates a high-grade, retracted tear of the gluteus medius tendon without fatty atrophy. What is the most appropriate next step in management?

. Endoscopic or open gluteus medius tendon repair
. Total hip arthroplasty
. Extracorporeal shockwave therapy
. IT band lengthening
. Proximal femoral osteotomy

Correct Answer & Explanation

. Endoscopic or open gluteus medius tendon repair

Explanation

Greater trochanteric pain syndrome (GTPS) often involves gluteus medius or minimus tendinopathy or tearing. In patients with high-grade, retracted tears who have failed prolonged conservative management and lack irreversible fatty atrophy, surgical repair is indicated and yields good functional outcomes.

Question 10

Topic: 3. Adult Reconstruction (Hip & Knee)

When comparing open distal clavicle resection with arthroscopic distal clavicle resection for osteolysis of the distal clavicle, arthroscopic techniques:

. Less reliably resect the appropriate amount of distal clavicle
. Less reliably provide pain relief
. Have a higher complication rate
. Result in a longer delay in return to sports
. Have no different outcomes

Correct Answer & Explanation

. Have no different outcomes

Explanation

A study comparing arthroscopic and open techniques of distal clavicular resection in the treatment of osteolysis of the distal clavicle found no difference in the amount of bone resected or amount of pain relief obtained. The arthroscopic group had a shorter hospital stay and less complications, and returned to activity nearly twice as fast as the open technique group.7

Question 11

Topic: 3. Adult Reconstruction (Hip & Knee)

A 24-year-old marathon runner is diagnosed with a femoral neck stress fracture. Radiographs show a fracture line on the tension side (superior aspect) of the femoral neck. What is the recommended treatment?

. Strict bed rest for 6 weeks
. Non-weight-bearing with crutches for 6 weeks
. Core decompression
. Internal fixation
. Total hip arthroplasty

Correct Answer & Explanation

. Internal fixation

Explanation

Tension-sided (superior) femoral neck stress fractures have a high risk of displacement and progressing to a complete fracture, which can lead to avascular necrosis. Therefore, they mandate urgent prophylactic internal fixation.

Question 12

Topic: 3. Adult Reconstruction (Hip & Knee)

Aseptic loosening secondary to osteolysis is a primary cause of long-term failure in total hip arthroplasty. The cellular cascade leading to periprosthetic osteolysis is primarily initiated by the activation of which of the following cell types upon phagocytizing polyethylene wear debris?

. Osteoblasts
. T-lymphocytes
. Fibroblasts
. Macrophages
. Chondrocytes

Correct Answer & Explanation

. Macrophages

Explanation

Macrophages phagocytize particulate polyethylene wear debris, leading to the release of inflammatory cytokines like TNF-alpha and IL-1. This cascade stimulates RANKL expression, which drives osteoclast activation and subsequent periprosthetic osteolysis.

Question 13

Topic: 3. Adult Reconstruction (Hip & Knee)

A 72-year-old man undergoes a primary total hip arthroplasty via a standard posterior approach. Six weeks postoperatively, he presents to the Emergency Department with severe hip pain after bending over to tie his shoes. His leg is noted to be shortened and internally rotated. Which of the following is the most likely diagnosis?

. Anterior hip dislocation
. Posterior hip dislocation
. Periprosthetic femur fracture
. Sciatic nerve palsy
. Acute periprosthetic joint infection

Correct Answer & Explanation

. Posterior hip dislocation

Explanation

A posterior hip dislocation classically presents with the affected limb shortened, internally rotated, and adducted. This complication is a known risk following THA via a posterior approach, particularly when the hip undergoes combined excessive flexion and internal rotation.

Question 14

Topic: 3. Adult Reconstruction (Hip & Knee)

During a posterior-stabilized total knee arthroplasty, trial components are placed. The knee is perfectly balanced in 90 degrees of flexion, but the extension gap is tight medially and loose laterally. Which of the following is the most appropriate next step to balance the knee?

. Release the lateral collateral ligament
. Release the deep medial collateral ligament
. Upsize the femoral component
. Increase the posterior slope of the tibial cut
. Recut the distal femur in more valgus

Correct Answer & Explanation

. Release the deep medial collateral ligament

Explanation

A tight medial extension gap with a balanced flexion gap indicates an asymmetric extension space requiring a specific medial release. Releasing the deep medial collateral ligament or performing a posteromedial capsular release will selectively open the medial side in extension without affecting flexion.

Question 15

Topic: 3. Adult Reconstruction (Hip & Knee)

During a primary total knee arthroplasty, the surgeon notes that the joint is excessively tight in flexion but well-balanced in extension. Which of the following is the most appropriate next step to balance the knee?

. Recut the distal femur to remove more bone
. Release the posterior capsule
. Downsize the femoral component
. Increase the thickness of the polyethylene insert
. Release the medial collateral ligament

Correct Answer & Explanation

. Downsize the femoral component

Explanation

A knee that is tight in flexion and well-balanced in extension has an asymmetric tight flexion gap. Downsizing the femoral component increases the flexion gap without affecting the extension gap.

Question 16

Topic: 3. Adult Reconstruction (Hip & Knee)

A 55-year-old male with a metal-on-metal total hip arthroplasty presents with progressive groin pain. Workup reveals a solid pseudotumor and elevated serum metal ions. Which histologic finding is most characteristic of this adverse local tissue reaction?

. Extensive polymorphonuclear leukocyte infiltration
. Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL)
. Foreign body giant cells surrounding polyethylene debris
. Monosodium urate crystals with negative birefringence
. Extensive acute fibrinoid necrosis with abundant eosinophils

Correct Answer & Explanation

. Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL)

Explanation

Adverse local tissue reaction (ALTR) in metal-on-metal implants is characterized histologically by ALVAL. This represents a delayed-type (Type IV) hypersensitivity reaction to metal ions.

Question 17

Topic: 3. Adult Reconstruction (Hip & Knee)

When comparing open distal clavicle resection with arthroscopic distal clavicle resection for osteolysis of the distal clavicle, arthroscopic techniques:

. Less reliably resect the appropriate amount of distal clavicle
. Less reliably provide pain relief
. Have a higher complication rate
. Require a longer hospital stay
. Allow quicker return to activity

Correct Answer & Explanation

. Allow quicker return to activity

Explanation

A study comparing arthroscopic and open techniques of distal clavicular resection in the treatment of osteolysis of the distal clavicle found no difference in the amount of bone resected or amount of pain relief obtained. The arthroscopic group had a shorter hospital stay, less complications, and returned to activity nearly twice as fast as the open group.

Question 18

Topic: 3. Adult Reconstruction (Hip & Knee)

Causes of distal clavicular osteolysis include all of the following except:

. Rheumatoid arthrosis
. Diabetes mellitus
. Sarcoidosis
. Hyperparathyroidism
. Repetitive microtrauma

Correct Answer & Explanation

. Diabetes mellitus

Explanation

Osteolysis of the distal clavicle has been associated with various conditions. Among the most common causes is repetitive microtrauma from activities such as weight lifting, gymnastics, and swimming. Other causes include rheumatoid arthrosis and hyperparathyroidism. The diagnosis of sarcoidosis should be considered in bilateral cases. Diabetes mellitus has not been associated with this condition.

Question 19

Topic: 3. Adult Reconstruction (Hip & Knee)
Which of the following findings has not been reported following abrasion arthroplasty as treatment for the painful, arthritic knee?
. An increase of the medial joint space on radiograph
. Intermediate or long-term symptomatic improvement in the majority of patients
. Formation of a fibrocartilage articular surface
. Formation of primarily type I collagen
. Worsening of symptoms in 10% to 20% of patients

Correct Answer & Explanation

. Intermediate or long-term symptomatic improvement in the majority of patients

Explanation

Although popular in the 1980s, abrasion arthroplasty for the treatment of osteoarthritis of the knee has not been shown to reliably improve patients' symptoms. Although some authors have found radiographic evidence of an increased joint space in approximately 50% of patients, these findings have not corresponded to an improvement in symptomatology. Abrasion arthroplasty results in the formation of a fibrocartilaginous articular surface that varies in composition with immature type I collagen predominant. Correct Answer: Intermediate or long-term symptomatic improvement in the majority of patients.

Question 20

Topic: 3. Adult Reconstruction (Hip & Knee)

Kummell disease is a recognized complication following a vertebral compression fracture. Which of the following best describes its classic radiographic presentation?

. Rapid onset of heterotopic ossification bridging the disc space
. Progressive kyphotic collapse with an intravertebral vacuum cleft
. Expansile lytic lesion involving the posterior elements
. Continuous ossification of the anterior longitudinal ligament
. Scalloping of the posterior vertebral body wall

Correct Answer & Explanation

. Progressive kyphotic collapse with an intravertebral vacuum cleft

Explanation

Kummell disease represents a delayed post-traumatic vertebral collapse resulting from avascular necrosis of the vertebral body. It characteristically presents with an intravertebral vacuum cleft on extension or traction radiographs.

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