3. Adult Reconstruction (Hip & Knee) MCQs

A 45-year-old female presents with persistent anterior groin pain 14 months after a primary THA. The pain is exacerbated when actively lifting her leg into a vehicle. Radiographs show the acetabular component in 15 degrees of anteversion with no signs of loosening, but a cross-table lateral view demonstrates the anterior edge of the cup is completely flush with the anterior acetabular rim. After 6 months of failed physical therapy and corticosteroid injections, what is the best surgical intervention?

A 55-year-old male with severe tri-compartmental knee osteoarthritis is scheduled for TKA. He has a history of a healed midshaft femoral fracture with a residual 22-degree extra-articular coronal varus deformity. Attempting an intra-articular resection to correct this deformity would compromise the collateral ligament attachments. What is the most appropriate surgical management?

In the concept of true kinematic alignment for total knee arthroplasty, the primary goal is to co-align the axes of the prosthetic components with the three kinematic axes of the native knee. Which axis serves as the primary reference for positioning the femoral component?

A 65-year-old woman presents with a catching sensation and pain in her anterior knee 1 year after a primary posterior-stabilized total knee arthroplasty. Range of motion is 0 to 120 degrees, and the catch occurs as the knee extends from 90 degrees of flexion. What is the primary etiology of this complication?

A 72-year-old man has a painful total hip arthroplasty (THA) 4 years postoperatively. Serum ESR is 45 mm/hr and CRP is 22 mg/L. Joint aspiration yields 2,500 WBC/uL with 75% PMNs. According to the 2018 ICM criteria, what is the next best step to confirm a periprosthetic joint infection?

A 55-year-old active male underwent a THA with a ceramic-on-ceramic bearing surface. Two years later, he reports an audible squeaking sound during hip flexion, but denies pain. What is the most significant risk factor for this phenomenon?

A 78-year-old woman sustains a fall 8 years after a primary cementless THA. She is unable to bear weight. Radiographs show a displaced fracture around the distal third of the femoral stem, with evidence of prior stem subsidence and severe proximal osteolysis.

What is the most appropriate management?

A 62-year-old woman with a metal-on-metal THA presents with new-onset groin pain and a palpable anterior mass. Serum cobalt and chromium levels are significantly elevated. MRI reveals a large cystic fluid collection with thick walls. What is the most appropriate management?

A 68-year-old man requires a TKA for severe osteoarthritis. He has a history of a femoral shaft fracture resulting in a 15-degree coronal plane extra-articular varus deformity.

How should this deformity ideally be managed during the TKA to ensure a balanced knee?

Which of the following patients is the most appropriate candidate for a metal-on-metal hip resurfacing arthroplasty (HRA)?

A 70-year-old man presents with knee pain 15 years after a primary cruciate-retaining TKA. Radiographs show eccentric polyethylene wear and a large uncontained osteolytic lesion in the medial tibial metaphysis. The components are radiographically stable. What is the most appropriate treatment?

A 68-year-old woman sustains a complete patellar tendon rupture 2 years after a primary TKA. Primary repair is attempted but fails. She undergoes extensor mechanism reconstruction with a synthetic mesh. What is the optimal postoperative rehabilitation protocol?

A 55-year-old man undergoes a medial unicompartmental knee arthroplasty (UKA). Postoperatively, radiographs reveal an overcorrection of the mechanical axis into 3 degrees of valgus. Which of the following is the most likely late complication of this specific alignment error?

A 65-year-old man reports progressive, insidious left groin pain 6 years after a primary metal-on-polyethylene total hip arthroplasty.

His serum inflammatory markers are normal. Joint aspiration yields sterile, dark, cloudy fluid with a white blood cell count of 1,200 cells/uL and 60% neutrophils. An MRI with metal artifact reduction sequence (MARS) reveals a thick-walled cystic mass communicating with the joint space. What is the most likely cause of this presentation?

During a primary posterior-stabilized total knee arthroplasty, the surgeon inserts the trial components and assesses the gaps. The knee is found to be symmetrically tight in both full extension and 90 degrees of flexion. Which of the following is the most appropriate next step to achieve a balanced knee?

A 55-year-old female presents with groin pain 6 years after undergoing a metal-on-metal total hip arthroplasty. Her serum cobalt level is 12 ppb and chromium is 9 ppb. MARS MRI demonstrates a symptomatic 4 cm cystic mass communicating with the joint. Infection has been ruled out. What is the most appropriate definitive management?

During a total hip arthroplasty, the surgeon decides to use a high-offset femoral stem instead of a standard-offset stem to optimize abductor mechanics. Assuming the leg length remains completely unchanged, what is the biomechanical effect of this decision?

A 68-year-old male presents with persistent pain and stiffness 18 months after a primary total knee arthroplasty. Serology shows an ESR of 45 mm/hr and a CRP of 25 mg/L. Joint aspiration yields a synovial fluid white blood cell (WBC) count of 4,500 cells/µL with 85% neutrophils. What is the most appropriate next step in management?

When evaluating a patient for a fixed-bearing medial unicompartmental knee arthroplasty (UKA), which of the following is widely considered an absolute contraindication?

A 62-year-old female presents with a painful 'catch' and a palpable 'pop' at the anterior aspect of her knee when she actively extends her knee from a flexed position. She underwent a posterior-stabilized total knee arthroplasty 14 months ago. Radiographs show well-fixed components with appropriate sizing. What is the most appropriate management?