3. Adult Reconstruction (Hip & Knee) MCQs

A 65-year-old man undergoes a posterior-stabilized total knee arthroplasty. Intraoperative trialing reveals the knee is perfectly balanced in full extension but is overly tight in 90 degrees of flexion. What is the most appropriate surgical step to balance the knee?

A 52-year-old man reports an audible squeaking noise from his right hip 3 years after a ceramic-on-ceramic total hip arthroplasty. He denies any pain or instability. What is the most common cause of this phenomenon?

During a total knee arthroplasty, the femoral component is inadvertently placed in 5 degrees of internal rotation relative to the surgical transepicondylar axis. This error is most likely to result in which of the following complications?

When performing a primary total hip arthroplasty via the direct anterior (Smith-Petersen) approach, the deep surgical interval is developed between which two muscles?

An 82-year-old woman sustains a fall 10 years after a primary total hip arthroplasty. Radiographs reveal a periprosthetic femur fracture extending around the tip of the stem. The stem is frankly loose, but there is excellent surrounding diaphyseal bone stock. According to the Vancouver classification, what is the best treatment?

A 66-year-old man presents with a chronically painful TKA. Joint aspiration is performed to rule out periprosthetic joint infection (PJI). The synovial fluid alpha-defensin test returns positive. What is the primary function of alpha-defensin in this context?

A 45-year-old woman presents with persistent anterior groin pain 1 year after an uncemented total hip arthroplasty. The pain is exacerbated by active straight leg raising. A cross-table lateral radiograph shows the acetabular component overhangs the anterior bone edge by 6 mm. What is the most appropriate initial management?

A 60-year-old woman complains of a painful 'catching' sensation at the anterior aspect of her knee when extending from a flexed position, 14 months after a posterior-stabilized total knee arthroplasty. What is the most likely etiology of this condition?

A 72-year-old woman undergoes revision total knee arthroplasty. Intraoperatively, she is noted to have a deficient medial collateral ligament (MCL) but an intact patellar tendon and adequate bone stock. Which type of implant constraint is most appropriate?

A direct lateral (Hardinge) approach is used for a primary total hip arthroplasty. To minimize the risk of denervation to the anterior portion of the abductor musculature, proximal splitting of the gluteus medius should be limited to what distance superior to the tip of the greater trochanter?

A 60-year-old man presents with a painful, swollen hip 6 years after a metal-on-polyethylene total hip arthroplasty. Aspirate yields fluid with a high lymphocyte count, but cultures are negative. Serum cobalt levels are highly elevated, while chromium is normal. What is the most likely diagnosis?

During total knee arthroplasty, the surgeon evaluates the gaps with trial components. The knee is tight in full extension but perfectly balanced at 90 degrees of flexion. Which of the following is the most appropriate corrective action?

A 55-year-old active male is undergoing total hip arthroplasty. He asks about bearing surface options. Which of the following bearing couples has the lowest volumetric wear rate while avoiding the risk of squeaking or stripe wear?

During a primary posterior-stabilized total knee arthroplasty, the knee is found to be well-balanced in extension but tight in flexion. Which of the following is the most appropriate adjustment to achieve a balanced gap?

A 72-year-old woman presents with thigh pain after a fall. A radiograph reveals a fracture around her cemented femoral stem.

The stem is visibly loose with subsidence, but the proximal femoral bone stock is adequate. According to the Vancouver classification, what is the most appropriate surgical treatment?

A 68-year-old man presents with acute onset of knee pain, swelling, and fever 3 weeks following a primary total knee arthroplasty. Aspiration yields a synovial white blood cell count of 65,000 cells/µL with 95% neutrophils. Which of the following is the most appropriate initial management?

A 54-year-old woman complains of groin pain 6 years after receiving a metal-on-metal total hip arthroplasty. Her radiograph shows a steep cup abduction angle. MRI demonstrates a large fluid collection around the joint.

Serum cobalt and chromium are significantly elevated. Which histological finding is most expected in the periprosthetic tissue?

A 65-year-old woman undergoes a posterior-stabilized total knee arthroplasty. Intraoperatively, with the trial components in place, the knee is stable in extension but exhibits significant laxity in flexion. Which of the following component changes is the most appropriate next step?

A 48-year-old active man complains of a loud, high-pitched squeaking noise coming from his right hip, particularly when bending to tie his shoes. He underwent an uncomplicated ceramic-on-ceramic total hip arthroplasty 2 years ago. Radiographs demonstrate a well-fixed stem and a cup with 65 degrees of inclination. What is the most likely cause of this phenomenon?

A 65-year-old woman undergoes a posterior-stabilized (PS) total knee arthroplasty. Postoperatively, she experiences a sense of instability when rising from a low chair. Evaluation reveals a cam-post dislocation. What is the primary mechanical feature that prevents this specific complication in a properly balanced PS TKA?