3. Adult Reconstruction (Hip & Knee) MCQs

During open reduction and internal fixation of a posterior wall acetabular fracture via a Kocher-Langenbeck approach, the surgeon identifies a large area of marginal impaction of the articular cartilage. What is the most appropriate management of this impacted fragment?

A 55-year-old female undergoes a primary total hip arthroplasty via a direct anterior approach. Postoperatively, she reports a burning numbness over the anterolateral aspect of her proximal thigh. Motor function is completely intact. Which nerve was most likely stretched or injured during the superficial surgical dissection?

A 58-year-old male, who has been living with HIV for 20 years and is on a stable antiretroviral therapy (ART) regimen, presents with debilitating right hip pain and radiographic evidence of severe osteoarthritis. His last CD4 count was 450 cells/µL, and his viral load has been undetectable for the past 18 months. He is otherwise healthy with well-controlled comorbidities. He is considering total hip arthroplasty (THA). Historically, HIV was considered a significant contraindication to major elective orthopedic procedures. Based on current evidence and the provided case, what is the most accurate statement regarding THA in this patient?

A 42-year-old female with a 15-year history of HIV, well-controlled on ART, presents with severe, bilateral hip pain that has progressively worsened over the past year. She denies any history of trauma. Radiographs reveal bilateral femoral head collapse and subchondral sclerosis. Her infectious disease specialist confirms a CD4 count of 380 cells/µL and an undetectable viral load. Given her presentation, which of the following is the most likely primary indication for total hip arthroplasty (THA) in this patient, and what are common contributing factors in PLWH?

During a total hip arthroplasty (THA) on a 65-year-old male with well-controlled HIV, the orthopedic surgeon notes that the femoral bone feels unusually soft and porous during reaming and broaching. The patient's preoperative DEXA scan had indicated osteopenia. This finding raises concerns about primary implant stability. Which of the following is the most appropriate intraoperative adaptation to address this HIV-specific biomechanical consideration?

A 35-year-old male with HIV presents with end-stage left knee osteoarthritis, refractory to conservative management. He is a candidate for total knee arthroplasty (TKA). His infectious disease specialist reports his current CD4 count is 180 cells/µL, and his viral load is 1500 copies/mL. He has also had a recent episode of oral candidiasis. Based on the provided guidelines, what is the most appropriate recommendation regarding his TKA?

A 50-year-old male with HIV, who has a history of well-controlled disease (CD4 count 600 cells/µL, undetectable viral load for 2 years), is scheduled for an elective total knee arthroplasty (TKA). As part of his preoperative workup, the orthopedic surgeon is reviewing the necessary consultations and tests. Which of the following is considered a mandatory and critical step in the preoperative planning for this patient, specifically due to his HIV status?

A 62-year-old male, 3 months post-total knee arthroplasty (TKA), presents with increasing knee pain, swelling, and warmth. He has a history of HIV, well-controlled preoperatively (CD4 500 cells/µL, undetectable viral load), but admits to missing several doses of his ART regimen in the past month due to financial difficulties. Aspiration of the knee joint confirms periprosthetic joint infection (PJI). What is the most critical HIV-specific consideration in the management of this patient's PJI?

A 48-year-old female with HIV, on a complex ART regimen including a protease inhibitor, undergoes an elective total hip arthroplasty. Postoperatively, she experiences significant pain and requires strong analgesia. The orthopedic team plans to prescribe a potent opioid for pain control. Based on the case information, what is the most important consideration when selecting and dosing perioperative medications for this patient?

A 70-year-old male with a long history of well-controlled HIV (CD4 count 550 cells/µL, undetectable viral load) undergoes a successful total hip arthroplasty for severe osteoarthritis. He is progressing well in the immediate postoperative period. During discharge planning, the physical therapist is reviewing the patient's home exercise program and activity restrictions. Which of the following is the most critical HIV-specific instruction to reinforce for this patient during his post-operative rehabilitation?

A 52-year-old male with well-controlled HIV (CD4 count 480 cells/µL, undetectable viral load) is 6 months post-total knee arthroplasty. He reports excellent pain relief and functional improvement. However, his orthopedic surgeon emphasizes the importance of long-term follow-up. Based on the case, what is a key long-term consideration for PLWH following TJA, particularly related to their underlying medical condition?

A 68-year-old male with a 25-year history of HIV, well-controlled on ART, is being evaluated for a revision total hip arthroplasty due to aseptic loosening of his femoral component. His current CD4 count is 420 cells/µL, and viral load is undetectable. He has a history of mild chronic kidney disease (CKD) and dyslipidemia, both managed medically. Based on the provided case, which of the following statements best summarizes the current evidence regarding TJA outcomes in well-controlled PLWH?

A 45-year-old male with a history of HIV on highly active antiretroviral therapy (HAART) presents with atraumatic, progressive groin pain. Radiographs demonstrate focal subchondral collapse of the femoral head. Which of the following components of his medical management is most strongly associated with the pathogenesis of this condition?

A 50-year-old HIV-positive patient is evaluated for an elective total knee arthroplasty due to severe osteoarthritis. Preoperative laboratory results show a CD4 count of 140 cells/mm3 and a detectable viral load. What is the most appropriate perioperative recommendation?

An HIV-positive patient with severe hemophilic arthropathy undergoes a total hip arthroplasty. Compared to patients with primary osteoarthritis, this patient is at the highest disproportionate risk for which of the following postoperative complications?

In an HIV-positive patient presenting for an elective joint replacement, which organism remains the most commonly isolated pathogen in cases that develop early postoperative prosthetic joint infection?

A 45-year-old HIV-positive patient is evaluated for an elective total hip arthroplasty. To minimize the risk of periprosthetic joint infection such that it approaches the baseline risk of an HIV-negative patient, what is the optimal minimum CD4 count required preoperatively?

A 60-year-old male with severe hemophilia A and HIV is planned for a total knee arthroplasty. Compared to HIV-negative osteoarthritic patients, this patient is at the highest increased risk for which of the following complications?

A 72-year-old female undergoes a primary total hip replacement (THR) via a posterior approach for severe osteoarthritis. Three weeks post-operatively, she presents to the emergency department with acute hip pain and inability to bear weight after attempting to pick up an object from the floor, resulting in a posterior dislocation. Radiographs confirm a posterior dislocation without periprosthetic fracture. After successful closed reduction, the surgeon reviews the case. Which of the following factors is LEAST likely to be the primary contributing cause of this early dislocation?