3. Adult Reconstruction (Hip & Knee) MCQs

The primary mode of wear in a well-functioning metal-on-highly cross-linked polyethylene total hip arthroplasty is:

During a direct lateral (Hardinge) approach to the hip, the gluteus medius is split longitudinally. To prevent denervation of the anterior portion of the gluteus medius and minimus, the proximal split should not extend beyond what distance from the tip of the greater trochanter?

When inserting screws into the acetabulum during a total hip arthroplasty, the "safe zone" for screw placement to avoid major neurovascular injury is which quadrant?

The medial circumflex femoral artery (MCFA) is at risk during a posterior approach to the hip if the dissection extends too far inferiorly. The MCFA typically passes between which two muscles before entering the hip capsule?

During a posterior approach to the hip, the surgeon identifies the medial femoral circumflex artery (MFCA) to protect the blood supply to the femoral head. What is the correct anatomic course of the main branch of the MFCA?

When placing screws into the acetabulum during a total hip arthroplasty, which quadrant is considered the 'safe zone' to avoid major neurovascular injury?

During a direct lateral (Hardinge) approach to the hip, proximal splitting of the gluteus medius must be limited to avoid denervating the anterior portion of the muscle. What is the generally accepted safe distance from the tip of the greater trochanter?

When placing acetabular screws during a total hip arthroplasty, the acetabulum is divided into four quadrants using a line from the anterior superior iliac spine through the center of the acetabulum and a second perpendicular line. A misdirected screw in the anterosuperior quadrant places which of the following structures at greatest risk?

A surgeon uses the direct lateral (Hardinge) approach to the hip, which involves splitting the gluteus medius. To avoid denervating the anterior portion of the gluteus medius and tensor fasciae latae, the split should not extend proximally from the tip of the greater trochanter more than:

Following a total hip arthroplasty via an anterior approach, a patient complains of burning pain and numbness over the anterolateral aspect of the operative thigh. The nerve responsible for this complication typically exits the pelvis in which location?

During a posterior approach to the hip, the short external rotators must be identified and tagged. Which of the following structures exits the pelvis through the lesser sciatic foramen?

When placing screws into the acetabulum during a total hip arthroplasty, the quadrant system is used to identify safe zones. Placement of a screw into the anterosuperior quadrant places which structure at highest risk of injury?

To avoid denervation of the hip abductors during a direct lateral (Hardinge) approach to the hip, the proximal split of the gluteus medius should be limited to what maximum distance from the tip of the greater trochanter?

During a total hip arthroplasty, the surgeon uses a high-offset femoral stem to restore the patient's native anatomy. What is the primary biomechanical effect of increasing femoral offset on hip kinematics and joint reaction forces?

During a posterior approach to the hip (Kocher-Langenbeck), the blood supply to the femoral head via the deep branch of the medial femoral circumflex artery (MFCA) is at risk. Which of the following structures acts as the primary anatomic barrier protecting the MFCA and should generally be preserved?

A 65-year-old female sustains a displaced femoral neck fracture. The primary blood supply to the weight-bearing dome of the adult femoral head is at high risk of disruption. Which of the following vessels provides this dominant vascular supply?

An 80-year-old woman with a well-functioning posterior-stabilized total knee arthroplasty (TKA) sustains a closed distal femur fracture above the prosthesis (Su Type II). Radiographs show the femoral component remains well-fixed. What is the preferred surgical treatment?

A 55-year-old female sustains a Dubberley Type 3B capitellum-trochlea fracture, characterized by a highly comminuted articular fragment involving the posterior condyle with complete loss of soft tissue attachment. Which surgical approach provides the best exposure for internal fixation?

A 72-year-old woman sustains an intertrochanteric femur fracture. Radiographs show the fracture line exiting the lateral cortex below the vastus ridge, indicating an incompetent lateral wall. Which of the following fixation implants is biomechanically optimal for this specific fracture pattern?

A 78-year-old woman presents with a periprosthetic femur fracture around a total hip arthroplasty implanted 10 years ago. Radiographs show a spiral fracture extending just distal to the tip of the stem. The stem is radiographically loose, but the proximal femoral bone stock is well-preserved. According to the Vancouver classification, how should this be managed?