3. Adult Reconstruction (Hip & Knee) MCQs

A 55-year-old active male underwent a total hip arthroplasty with a ceramic-on-ceramic bearing surface 3 years ago. He now complains of a high-pitched squeaking noise during activity. Which of the following factors is most strongly associated with this complication?

A patient had a fixed deformity of the hallux interphalangeal (IP) joint (Slide) for 3 years following forefoot surgery. She complains of pain over the distal aspect of the hallux where rubbing occurs on the shoe. On examination, the hallux is flexible at the metatarsophalangeal (MP) and IP joints, there is no crepitus of the MP joint, and radiographs demonstrate normal alignment of the first metatarsal. The recommended procedure for correcting this deformity is:

Which of the following bearing surface combinations in total hip arthroplasty historically demonstrates the lowest volumetric wear rate?

During a posterior-stabilized total knee arthroplasty, the surgeon notes that the knee is tight in flexion and well-balanced in extension. Which of the following maneuvers is most appropriate to balance the knee?

A 45-year-old highly active male is undergoing a total hip arthroplasty. To minimize wear rates and the risk of osteolysis, which of the following bearing surface combinations is most appropriate?

One year following a posterior-stabilized total knee arthroplasty, a patient presents with a painful popping sensation when extending the knee from a flexed position. What is the most likely etiology?

A 24-year-old man presents for treatment of a painful fifth toe deformity. He had the deformity for 10 years and notes that it is getting progressively worse. On examination, a claw toe deformity is present. There is 90° of fixed hyperextension of the metatarsophalangeal joint, 70° of flexion at the interphalangeal joint, and a painful corn on the distal tip of the phalanx. The patient would like surgical correction. Which procedure is most likely to give him relief of pain and correction of deformity:

A 56-year-old woman presents for evaluation and treatment of a painful hallux. She notes the pain over the dorsal surface of the hallux metatarsophalangeal (MP) joint and on the plantar aspect of the hallux interphalangeal (IP) joint. C linically, there is no range of motion in dorsiflexion of the hallux MP joint, pain upon attempted movement of the MP joint, and 20° of extension of the hallux IP joint. Radiographs demonstrate arthritis of the hallux MP joint and normal alignment of the first metatarsal. The surgical procedure that is likely to cause further mechanical problems for this patient is:

A 70-year-old female presents with recurrent posterior dislocations following a primary total hip arthroplasty. Radiographic evaluation shows the acetabular component is placed in 10 degrees of anteversion and 30 degrees of inclination. What is the most appropriate surgical intervention?

A 68-year-old male is 5 years post-primary total knee arthroplasty and presents with a swollen, painful knee. Aspirate reveals 65,000 WBC/hpf with 95% polymorphonuclear cells. What is the most widely accepted surgical treatment for this chronic periprosthetic joint infection?

A 62-year-old woman undergoes an uncomplicated total hip arthroplasty using a ceramic-on-ceramic bearing surface. Two years postoperatively, she complains of an audible 'squeaking' sound from her hip during walking. What surgical factor is most strongly associated with this phenomenon?

A 16-year-old female soccer player sustains a non-contact pivoting injury to her knee. MRI confirms an isolated rupture of the anterior cruciate ligament (ACL). Which of the following anatomic factors is most strongly associated with an increased risk for this specific injury pattern?

A 65-year-old woman undergoes a primary total hip arthroplasty via a posterior approach. Six weeks postoperatively, she presents to the emergency department with a posterior dislocation that occurred while rising from a low toilet seat. Which of the following component positions is most likely responsible for this instability?

A 63-year-old woman who underwent attempted correction of a hallux valgus deformity 3 years previously presents to the office. She has pain in the hallux from dorsal abutment of the hallux on the shoe. There is no pain in the lesser toes or metatarsals. The recommended procedure to alleviate the irritation of the hallux is:

Following a primary total hip arthroplasty via a posterior approach, a patient experiences recurrent posterior dislocations. Radiographs demonstrate an acetabular cup with 5 degrees of retroversion and 45 degrees of inclination. What is the most appropriate surgical intervention?

A 66-year-old woman presents with right knee pain 3 years after a total knee arthroplasty. Her ESR is 45 mm/hr and CRP is 22 mg/L. Joint aspiration yields synovial fluid with a WBC count of 4,500 cells/uL with 85% polymorphonuclear leukocytes. Which of the following tests would provide the highest specificity for confirming a periprosthetic joint infection (PJI)?

A 65-year-old man who underwent a metal-on-metal total hip arthroplasty 8 years ago presents with groin pain and a palpable mass. Serum cobalt and chromium levels are significantly elevated. Aspiration yields sterile, cloudy fluid. Histopathology of the periprosthetic tissue is most likely to show which of the following?

A 78-year-old woman with a history of severe osteoporosis presents with a displaced intracapsular femoral neck fracture (Garden IV). She is an independent community ambulator but suffers from mild Alzheimer's dementia. Which of the following is the most appropriate surgical treatment?