3. Adult Reconstruction (Hip & Knee) MCQs

Which of the following vessels is the primary contributor to the blood supply of the adult femoral head?

During a direct anterior approach for total hip arthroplasty, the lateral femoral cutaneous nerve is at risk. To minimize injury, the surgeon should remember that the nerve typically courses:

During a posterior approach to the hip, protecting the medial circumflex femoral artery (MFCA) is critical. The main branch of the MFCA typically courses posterior to the obturator externus tendon and anterior to which of the following muscles?

A 65-year-old man presents with groin pain 15 years after an uncemented total hip arthroplasty.

Radiographs show extensive expansile radiolucencies around the acetabulum. Which of the following is the primary cell type responsible for initiating the bone resorption seen in this condition?

A surgeon is performing a direct lateral (Hardinge) approach to the hip. To avoid injury to the superior gluteal nerve, the proximal split in the gluteus medius should not extend beyond what distance from the tip of the greater trochanter?

A 42-year-old woman with a history of systemic lupus erythematosus presents with progressive hip pain.

An MRI confirms early-stage avascular necrosis (Ficat Stage II) with no subchondral collapse. What is the most appropriate initial surgical intervention?

A 55-year-old man who underwent a metal-on-metal total hip arthroplasty 8 years ago presents with new-onset groin pain and a palpable mass. Aspiration yields sterile, cloudy fluid. What is the most likely pathological mechanism?

A 40-year-old man with ankylosing spondylitis requires bilateral total hip arthroplasties for severe secondary osteoarthritis. Compared to osteoarthritis patients, this patient is at a significantly higher risk for which postoperative complication?

A 65-year-old female presents with recurrent posterior instability of her total hip arthroplasty (THA). Radiographic evaluation reveals an anteversion angle of 5 degrees and an inclination angle of 40 degrees for the acetabular component. Which of the following is the most appropriate definitive management?

A 40-year-old woman with a history of systemic lupus erythematosus treated with corticosteroids presents with progressive hip pain. MRI reveals a double-line sign on T2-weighted images with no evidence of subchondral collapse or flattening of the femoral head. Which of the following joint-preserving interventions is most indicated?

A 60-year-old man presents with chronic lateral hip pain 5 years after a metal-on-polyethylene total hip arthroplasty. Serum inflammatory markers are normal, but a metal artifact reduction sequence (MARS) MRI reveals a large solid/cystic pseudotumor in the periprosthetic tissues. What is the most likely etiology of this finding?

A surgeon is counseling a young, active patient regarding bearing surface options for a planned total hip arthroplasty. If a ceramic-on-ceramic bearing is chosen, the patient should be counseled that compared to highly cross-linked polyethylene, ceramic-on-ceramic has a higher risk of which of the following?

Following a cementless total hip arthroplasty, a patient sustains a displaced periprosthetic femoral fracture localized around the tip of a well-fixed femoral stem (Vancouver Type B1). What is the gold standard of treatment for this specific injury?

A 28-year-old man sustains a displaced Pauwels type III femoral neck fracture. What is the most appropriate definitive management to minimize the risk of avascular necrosis and nonunion?

During a posterior approach to the hip, extreme external rotation of the femur places which of the following vascular structures at highest risk, potentially compromising the main blood supply to the adult femoral head?

A 65-year-old woman sustains a posterior hip dislocation 4 weeks after undergoing primary total hip arthroplasty via a posterior approach. Radiographs show the acetabular cup has 10 degrees of anteversion and 45 degrees of abduction. What is the most likely cause of this instability?

A 45-year-old man undergoes total hip arthroplasty with an alumina ceramic-on-ceramic bearing. At his 3-year follow-up, he complains of a high-pitched squeaking noise when walking. Which of the following factors is most strongly associated with this phenomenon?

A 30-year-old woman with systemic lupus erythematosus on chronic corticosteroids presents with progressive groin pain. Radiographs show a subchondral lucent crescent in the anterosuperior aspect of the femoral head with mild flattening, but no joint space narrowing (Ficat Stage III). What is the most appropriate surgical treatment?

A 68-year-old man reports persistent lateral hip pain and a severe limp 6 months following a primary total hip arthroplasty via a direct lateral (Hardinge) approach. Examination reveals a positive Trendelenburg test. MRI with metal artifact reduction shows a complete, retracted tear of the abductor tendon insertion. What is the most appropriate next step after failing conservative care?

A 55-year-old woman undergoes total hip arthroplasty. To achieve adequate soft tissue stability without over-lengthening the leg, the surgeon utilizes a high-offset femoral stem. Increasing femoral offset in total hip arthroplasty primarily achieves which of the following?