3. Adult Reconstruction (Hip & Knee) MCQs

In the manufacturing process of highly cross-linked polyethylene (HXLPE) for total hip arthroplasty, post-irradiation melting above the melting temperature (135 degrees Celsius) alters the material's properties. Which of the following statements best describes the result of this thermal treatment?

A 68-year-old woman presents with a painful, audible clunking sensation when extending her knee from a flexed position. She underwent a primary posterior-stabilized total knee arthroplasty 14 months ago. What is the most appropriate surgical management for this condition?

A 72-year-old woman sustains a periprosthetic femur fracture 8 years after a cemented total hip arthroplasty. Radiographs demonstrate a fracture spiral around the tip of the stem, accompanied by stem subsidence and focal osteolysis in the proximal femur, though distal bone stock is robust. What is the most appropriate treatment?

During the femoral preparation of a total knee arthroplasty, the surgeon inadvertently places the femoral component in excessive internal rotation. Which of the following intraoperative findings is the direct result of this specific error?

A 55-year-old active man who underwent a total hip arthroplasty with a ceramic-on-ceramic bearing 2 years ago presents with a loud, audible squeaking from his hip during ambulation. Radiographic evaluation is most likely to reveal which of the following acetabular component malpositions as the primary contributor?

A 58-year-old man with isolated medial compartment osteoarthritis is being evaluated for a unicompartmental knee arthroplasty (UKA). Which of the following findings on clinical and radiographic evaluation represents a strict contraindication to a mobile-bearing UKA?

A 64-year-old man presents with a painful groin mass 5 years after receiving a metal-on-polyethylene total hip arthroplasty using a large 36-mm cobalt-chromium femoral head. Joint aspiration reveals thick, sterile fluid with a low WBC count. Serum cobalt levels are significantly higher than chromium levels. What is the most likely diagnosis?

During a total hip arthroplasty, the surgeon meticulously restores the patient's native femoral offset. Which of the following biomechanical advantages is achieved by this specific surgical goal?

A patient reports persistent knee instability and giving way when descending stairs 1 year after a total knee arthroplasty. On examination, the knee is completely stable at 0 degrees and 90 degrees of flexion, but exhibits profound laxity at 45 degrees of flexion. Radiographs demonstrate significant joint line elevation. What is the most likely underlying cause?

A 55-year-old active male presents with an audible squeaking sound from his hip 2 years after a ceramic-on-ceramic total hip arthroplasty. Which of the following component positions is most highly associated with this complication?

During a total knee arthroplasty, the surgeon evaluates the gaps and notes a symmetric, balanced flexion gap but an extension gap that is tight symmetrically. Which of the following is the most appropriate surgical maneuver to balance the knee?

A 60-year-old female complains of new-onset anterior groin pain 6 months following an uncomplicated primary total hip arthroplasty. Pain is reproducible with active straight leg raise and resisted hip flexion. Radiographs demonstrate an un-cemented acetabular cup with 10 degrees of anteversion and 40 degrees of inclination. What is the most likely cause of her symptoms?

A patient presents with a painful popping sensation in the anterior knee 1 year after a posterior stabilized total knee arthroplasty. The pop occurs consistently as the knee moves from flexion to extension, typically around 30 to 40 degrees of flexion. What is the most appropriate initial surgical management?

In an effort to optimize hip biomechanics during total hip arthroplasty, a surgeon plans to medialize the center of rotation of the acetabulum. Which of the following best describes the mechanical effect of this maneuver?

A 72-year-old male presents with acute thigh pain and inability to bear weight after a minor fall. Radiographs demonstrate a periprosthetic femur fracture around a cemented total hip arthroplasty stem. The fracture is located at the tip of the stem, the stem is radiographically loose, and there is good proximal femoral bone stock. Which classification and treatment are most appropriate?

During a total knee arthroplasty for a severe fixed valgus deformity, the surgeon proceeds with a lateral soft tissue release. According to the standard inside-out technique, which structure is typically released first after osteophytes are removed?

A surgeon performs a lateral retinacular release during a total knee arthroplasty to improve patellar tracking. Which vessel is at greatest risk of injury during this procedure, potentially leading to patellar avascular necrosis?

A patient develops a foot drop and decreased sensation over the dorsum of the foot immediately following a primary total hip arthroplasty via a posterior approach. Which specific nerve division is most commonly injured in this scenario?

A patient presents with a painful total knee arthroplasty 3 years postoperatively. Synovial fluid analysis reveals an elevated alpha-defensin level. What is the primary source of alpha-defensin in the setting of a periprosthetic joint infection?

A 65-year-old female with a documented severe type IV hypersensitivity reaction to nickel requires a primary total knee arthroplasty. Which of the following femoral component materials is most appropriate to use in this patient?