3. Adult Reconstruction (Hip & Knee) MCQs

A patient with severe lateral bowing of the femur in the coronal plane is undergoing a TKA. If a standard straight intramedullary alignment rod is used without adjustments, what will be the likely effect on the distal femoral resection?

A 65-year-old man presents with acute knee pain, swelling, and fever 4 weeks after an uncomplicated primary TKA. Symptoms began 2 days ago. Aspiration yields 85,000 WBC/hpf with 95% neutrophils. Implants are well-fixed radiographically. What is the treatment of choice?

A lateral opening wedge distal femoral osteotomy (DFO) is planned for a young patient with symptomatic valgus osteoarthritis. Compared to a medial closing wedge DFO, what is the expected effect on leg length?

During a total knee arthroplasty for a severe fixed valgus deformity, the surgeon notes that the lateral compartment remains excessively tight in flexion but is balanced in extension. Release of which structure will most effectively address this mismatch?

Which of the following is considered an absolute contraindication to a mobile-bearing medial unicompartmental knee arthroplasty (UKA)?

A surgeon inadvertently overstuffs the patellofemoral joint during a total knee arthroplasty by using an excessively thick patellar component. What is the most likely clinical manifestation of this error?

A patient presents with severe arthrofibrosis (ROM 5 to 65 degrees) following a primary total knee arthroplasty. According to the literature, manipulation under anesthesia (MUA) is most successful when performed within what postoperative timeframe?

When setting the distal femoral cut angle during a TKA, the surgeon must account for the angle between the anatomical and mechanical axes. In a short patient with short femora, how does this valgus angle typically compare to a tall patient?

During a primary total knee arthroplasty (TKA) for a severe varus deformity, the surgeon evaluates the gaps after preliminary medial releases. The joint is perfectly balanced in 90 degrees of flexion, but the medial side remains significantly tighter than the lateral side in full extension. Which of the following structures should be released next to achieve balance?

A surgeon is performing a primary TKA on a severe valgus knee using a sequential lateral release. If the popliteus tendon is completely resected from its femoral insertion during this process, what is the most likely resulting biomechanical consequence?

A patient develops patellar clunk syndrome after a posterior-stabilized (PS) TKA. Which of the following technical errors during the primary surgery is most likely responsible for exacerbating this condition?

An 80-year-old patient presents with a massive osteolytic defect in the medial tibial metaphysis 15 years post-TKA. The cortical rim is completely deficient medially, and the tibial baseplate has subsided. According to the Anderson Orthopaedic Research Institute (AORI) classification, this Type 3 defect is best managed by which of the following during revision?

One year after undergoing a primary total knee arthroplasty, a 65-year-old man has a 1-week history of new onset anterior knee pain. He can perform a straight-leg raise with no extension lag. Radiographs reveal a transverse patella fracture with 8 mm of displacement and an intact patellar component. The best course of treatment is

A 55-year-old female presents with progressive groin pain 6 years after a metal-on-metal total hip arthroplasty. MRI with MARS reveals a large cystic pseudotumor. Laboratory testing shows elevated serum cobalt and chromium levels. During revision surgery, extensive abductor muscle necrosis is noted. Which histologic feature is most characteristic of this adverse local tissue reaction (ALTR)?

An 80-year-old female presents with a periprosthetic femur fracture around a cemented total hip arthroplasty stem. Radiographs show a spiral fracture extending just below the tip of the stem. The stem is radiographically loose, and there is significant cortical thinning and osteolysis of the proximal femur. According to the Vancouver classification, how is this fracture classified?

A 65-year-old male who underwent a metal-on-metal total hip arthroplasty 8 years ago presents with new-onset groin pain and a palpable anterior mass. Joint aspiration yields sterile fluid with a high macrophage count. Blood cobalt and chromium levels are markedly elevated. Histological examination of the periprosthetic tissue during revision surgery is most likely to reveal which of the following?

A 65-year-old male with a ceramic-on-ceramic total hip arthroplasty presents with a squeaking hip. Radiographs demonstrate a steep acetabular cup with an inclination angle of 60 degrees. Which of the following wear patterns is most likely occurring at the bearing surface?

What is the most common mode of long-term failure in a semiconstrained (linked) total elbow arthroplasty (TEA)?

A 62-year-old female with a metal-on-polyethylene total hip arthroplasty utilizing a large-diameter modular cobalt-chrome head presents with new-onset groin pain and an enlarging cystic pelvic mass on MRI. Aspiration yields sterile, cloudy, greenish fluid. What is the most likely primary etiology of this adverse local tissue reaction?

During a total hip arthroplasty, the surgeon elects to use a ceramic-on-ceramic bearing surface. Postoperatively, the patient returns complaining of a loud 'squeaking' noise from the hip during specific movements. Which of the following technical factors is most strongly associated with an increased risk of squeaking in ceramic-on-ceramic hips?