3. Adult Reconstruction (Hip & Knee) MCQs

An 18-year-old football player sustains a high-energy impact to his medial shoulder. He presents to the emergency department in extreme pain, with dysphagia, a sensation of choking, and a clinically absent medial clavicle prominence. What is the most appropriate next step in management?

Type IV delayed hypersensitivity reactions have been implicated in some cases of unexplained pain and aseptic loosening in total joint arthroplasty. This immunological reaction is primarily mediated by which cells?

The process of aseptic loosening in total joint arthroplasty is largely driven by particulate wear debris. Which of the following cell types is primarily responsible for phagocytosing this debris and releasing pro-inflammatory cytokines?

In total hip arthroplasty, accelerated generation of polyethylene wear debris due to a fragment of bone cement becoming trapped between the femoral head and acetabular liner is an example of:

A modular total hip arthroplasty fails due to severe tribocorrosion at the head-neck junction. What specific type of wear is characterized by microscopic oscillatory motion between two solid surfaces under load?

Aseptic loosening of cementless total hip stems can occur secondary to localized proximal femoral osteopenia. This phenomenon, known as stress shielding, occurs because the rigid metal implant:

During revision of an uncemented total hip arthroplasty, severe polyethylene wear is noted secondary to retained bone and cement particles from a previous surgery acting between the articular surfaces. What type of wear mechanism is this?

Which of the following represents the primary mechanical disadvantage of ceramic-on-ceramic bearings in total hip arthroplasty?

A patient develops significant proximal femoral bone loss two years after an uncemented total hip arthroplasty utilizing a diaphyseal-fitting, extensively porous-coated cobalt-chromium stem. The primary mechanism for this bone loss is:

Stress shielding, frequently observed radiographically as proximal femoral osteopenia around a stiff primary arthroplasty stem, is a direct clinical manifestation of which biomechanical principle?

During a direct lateral (Hardinge) approach to the hip, proximal splitting of the gluteus medius is limited to prevent injury to the superior gluteal nerve. What is the generally accepted maximum safe distance for splitting the gluteus medius proximal to the tip of the greater trochanter?

In a direct anterior approach to the hip, careful deep dissection is required. In a different scenario where an adductor tenotomy and obturator nerve block are performed for spasticity, the surgeon isolates the anterior and posterior divisions of the obturator nerve. These divisions are anatomically separated by which of the following muscles?

During a posterior approach to the hip (Kocher-Langenbeck), preservation of the main blood supply to the adult femoral head is critical. To protect the ascending branch of the medial femoral circumflex artery (MFCA), the surgeon should strictly avoid transecting the tendon of the:

During a posterior approach to the hip (Kocher-Langenbeck), which of the following short external rotators should be preserved to protect the deep branch of the medial circumflex femoral artery?

During a posterior approach to the hip for a total hip arthroplasty, excessive bleeding is encountered near the inferior border of the quadratus femoris. Ligation of the vessels in this area puts the primary blood supply to the femoral head at risk. Which artery is responsible for this blood supply and passes between the quadratus femoris and the obturator externus?

A 3-year-old boy presents with a painless limp. Examination shows a positive Trendelenburg gait and Galeazzi sign on the right. Radiographs confirm an untreated right developmental dislocation of the hip. What is the most appropriate surgical management?