3. Adult Reconstruction (Hip & Knee) MCQs

Which patient or surgical factor is most strongly associated with squeaking in a ceramic-on-ceramic total hip arthroplasty?

A 48-year-old active female with hip osteoarthritis desires a hip resurfacing arthroplasty. Which of the following is the most significant risk factor for early failure in this patient?

A 60-year-old male presents with groin pain 6 years after a THA utilizing a large-diameter metal head on a standard titanium stem. Aspiration is negative for infection, but MRI shows a large cystic mass. What mechanism is most likely responsible?

During a total knee arthroplasty, trial reduction reveals a tight extension gap and a loose flexion gap. Which of the following surgical maneuvers is the most appropriate next step to balance the knee?

A 68-year-old patient with a metal-on-polyethylene total hip arthroplasty presents with new-onset groin pain 6 years postoperatively. Radiographs show well-fixed components with no signs of osteolysis. Laboratory testing reveals elevated serum cobalt levels with normal serum chromium levels. What is the most likely cause of these findings?

Understanding spino-pelvic mechanics is crucial for preventing instability after total hip arthroplasty. In a normal patient, transitioning from a standing to a seated position causes the pelvis to tilt posteriorly. How does this normal posterior pelvic tilt affect the orientation of the acetabulum?

During a primary total hip arthroplasty utilizing the direct anterior approach (Hueter interval), the surgeon must routinely identify and ligate an ascending arterial branch traversing the surgical field to prevent excessive bleeding. This vessel is a branch of which of the following arteries?

During the femoral preparation of a total knee arthroplasty, the surgeon inadvertently places the femoral component in internal rotation relative to the transepicondylar axis. This error will most likely result in which of the following postoperative biomechanical issues?

A 70-year-old female presents with a painful catching sensation in her knee one year after undergoing a posterior-stabilized total knee arthroplasty. The catch occurs during active extension from a flexed position of approximately 40 degrees. What is the most likely diagnosis?

A 75-year-old female sustains a fall 8 years after an uncomplicated cementless total hip arthroplasty.

Radiographs demonstrate a fracture around the distal aspect of the stem. The stem demonstrates evidence of subsidence and loosening, but the proximal femoral bone stock remains adequate. Based on the Vancouver classification, what is the most appropriate definitive management?

During a primary total knee arthroplasty, the trial components are placed. The surgeon notes that the knee is tight in flexion but symmetrically balanced in extension. Which of the following is the most appropriate next step to balance the knee?

A 65-year-old female with a metal-on-polyethylene total hip arthroplasty presents with new-onset groin pain. Radiographs show well-fixed components. Laboratory evaluation reveals elevated serum cobalt levels and normal chromium levels. Inflammatory markers are normal. What is the most likely diagnosis?

A 72-year-old female sustains a periprosthetic femur fracture around a cemented total hip arthroplasty. Radiographs reveal a fracture around the tip of the stem with radiolucent lines indicating a loose stem, but adequate femoral bone stock remains. According to the Vancouver classification, what is the most appropriate surgical management?

Four weeks following a primary total knee arthroplasty, a patient presents with sudden onset knee pain, erythema, and swelling. Synovial fluid analysis reveals a WBC count of 65,000 cells/uL with 92% neutrophils. Which of the following is the most appropriate initial surgical treatment?

Following a primary TKA, the surgeon observes that the patella subluxates laterally during deep knee flexion. Which of the following component malpositions is the most likely technical cause?

A 55-year-old active male with a ceramic-on-ceramic THA complains of an audible squeaking sound from his hip when walking. Which of the following is the most significant risk factor for this phenomenon?

During a primary posterior-stabilized total knee arthroplasty, trial components demonstrate a balanced and stable extension gap, but the knee is excessively tight in flexion. Which of the following is the most appropriate corrective action?

A 65-year-old female presents with recurrent posterior dislocations following a primary total hip arthroplasty. Evaluation reveals a combined anteversion of 15 degrees. Which of the following is the primary mechanical cause of her instability?

A 60-year-old male presents with right hip pain 5 years after a metal-on-polyethylene THA. Aspiration yields a sterile effusion with normal inflammatory markers but an elevated serum cobalt level. MRI reveals a solid pseudotumor. What is the most likely source of the metal debris?

A 72-year-old patient sustains a periprosthetic femur fracture 10 years after a cementless THA. Radiographs show a fracture around the tip of the stem. The stem is radiographically loose, but the proximal bone stock is well preserved. According to the Vancouver classification, what is the most appropriate treatment?