3. Adult Reconstruction (Hip & Knee) MCQs

A 55-year-old male undergoes a total hip arthroplasty utilizing a ceramic-on-ceramic bearing surface. One year later, he complains of a highly audible 'squeaking' noise when walking. Which of the following factors is most strongly associated with this phenomenon?

In total hip arthroplasty, the use of highly cross-linked polyethylene (HXLPE) has significantly reduced wear rates compared to conventional polyethylene. Which of the following mechanical properties is most likely decreased as a direct result of the high-dose irradiation process used to create HXLPE?

A 68-year-old female presents with an audible and palpable 'clunk' in her knee 9 months after a posterior-stabilized total knee arthroplasty. The clunk occurs as the knee actively extends from 45 degrees of flexion. What is the most likely pathophysiologic cause of this phenomenon?

A 65-year-old woman undergoes total hip arthroplasty using a highly cross-linked polyethylene liner. What is the primary negative biomechanical consequence of increasing the radiation dose during the cross-linking process of the polyethylene?

When diagnosing a periprosthetic joint infection (PJI), clinicians often rely on the Musculoskeletal Infection Society (MSIS) criteria. Which of the following findings is considered one of the 'major' criteria, which by itself is definitively diagnostic for a PJI?

Which of the following defines the "safe zone" for acetabular component positioning in total hip arthroplasty as classically described by Lewinnek?

During a total knee arthroplasty, after making the initial bone cuts and inserting trial components, the surgeon notes that the knee is symmetric and stable in extension, but tight symmetrically in flexion. What is the most appropriate corrective step?

In total hip arthroplasty, the use of highly cross-linked polyethylene (HXLPE) significantly reduces volumetric wear. However, the radiation cross-linking and subsequent thermal treatment processes result in which of the following biomechanical trade-offs?

During a cruciate-retaining total knee arthroplasty, the trial reduction reveals that the knee is well-balanced and symmetric in full extension but is excessively tight in 90 degrees of flexion. Which of the following surgical modifications is most appropriate to balance the knee?

During a posterior-stabilized total knee arthroplasty (TKA), the surgeon observes excessive femoral rollback resulting in severe posterior impingement of the tibial post against the femoral cam during deep flexion. Which of the following technical errors is the most likely cause of this kinematic abnormality?

Which of the following factors is most strongly associated with the phenomenon of 'squeaking' following a Ceramic-on-Ceramic total hip arthroplasty?

During the trial reduction phase of a posterior-stabilized total knee arthroplasty, the surgeon notes that the knee is exceptionally tight in flexion (difficulty reaching 90 degrees), but it is stable, fully extended, and well-balanced in extension. Which of the following is the most appropriate surgical adjustment?

During the trialing phase of a posterior-stabilized total knee arthroplasty, the knee is found to be symmetrically tight in flexion but well-balanced and stable in extension. Which of the following is the most appropriate next surgical step to balance the knee?

When performing a cemented total hip arthroplasty using a collarless, polished, taper-slip femoral stem (e.g., the Exeter stem), which of the following biomechanical principles describes the primary mechanism by which the stem achieves long-term stability within the cement mantle?

A 65-year-old female presents with groin pain and swelling three years after undergoing a primary total hip arthroplasty utilizing a metal head on a highly cross-linked polyethylene liner with a titanium femoral stem. Metal ion analysis and MRI are suggestive of trunnionosis (mechanically assisted crevice corrosion). Which of the following serum metal ion profiles is most characteristic of this specific complication?

A 68-year-old male is evaluated for isolated anterior knee pain with a palpable 'catching' sensation when extending his knee from a flexed position. He underwent a posterior-stabilized total knee arthroplasty 18 months ago. Examination reveals a painful snap at approximately 30 to 40 degrees of knee flexion during active extension. What is the most definitive and appropriate treatment for this condition?

During trialing in a primary total knee arthroplasty, the knee is found to be well-balanced and symmetric in full extension, but the flexion gap is unacceptably tight. Which of the following maneuvers is the most appropriate next step to balance the knee?

The introduction of highly cross-linked polyethylene (HXLPE) in total hip arthroplasty has significantly reduced volumetric wear rates. However, the radiation cross-linking process detrimentally affects which of the following material properties?

During a posterior-stabilized total knee arthroplasty, using a measured resection technique, the surgeon assesses the gaps with trial components. The knee is symmetric and perfectly balanced in extension, but it is symmetrically tight in flexion. What is the most appropriate next step to balance the knee without altering the extension gap?