3. Adult Reconstruction (Hip & Knee) MCQs

An 82-year-old woman with severe rheumatoid arthritis and advanced osteopenia sustains a comminuted, intra-articular distal humerus fracture (AO/OTA type 13-C3). Compared to open reduction and internal fixation (ORIF), primary total elbow arthroplasty (TEA) for this specific patient is most likely associated with:

During revision surgery of a modular total hip arthroplasty, the surgeon notes black particulate debris and severe tissue staining around the modular head-neck junction. The implant system consists of a titanium-alloy femoral stem and a cobalt-chromium alloy femoral head. Which combination of corrosive mechanisms is primarily responsible for this specific presentation (trunnionosis)?

A 60-year-old woman presents with groin pain and a palpable mass over her total hip arthroplasty. Her implant features a modular femoral neck-stem junction with a titanium stem and cobalt-chromium neck. Aspiration shows aseptic, metal-stained fluid. She is diagnosed with an adverse local tissue reaction (ALTR). The primary mode of corrosion occurring at this specific modular junction is:

In metal-on-polyethylene total hip arthroplasty, the most common mechanism of wear leading to the generation of clinically significant submicron polyethylene particles, osteolysis, and subsequent aseptic loosening is characterized by a harder surface scratching and plowing into a softer surface. What is the specific tribological term for this type of wear?

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

During a posterior (Kocher-Langenbeck) approach to the hip, which structure provides the primary protection to the medial femoral circumflex artery (MFCA) during the capsulotomy?

Which specific branch of the medial circumflex femoral artery (MCFA) provides the primary blood supply to the weight-bearing dome of the femoral head in an adult, making it critical to protect during posterior approaches to the hip?

To prevent avascular necrosis during surgical dislocation of the hip, the surgeon must carefully protect the main blood supply to the femoral head, the medial circumflex femoral artery (MCFA). The deep branch of the MCFA consistently traverses between which two muscles?

A surgeon is performing a posterolateral approach to the hip for total hip arthroplasty. To minimize the risk of avascular necrosis and preserve the main blood supply to the femoral head, aggressive release or division of the quadratus femoris muscle near its femoral insertion should be avoided. The vessel protected by this maneuver is the:

During a posterior approach to the hip (Kocher-Langenbeck), the short external rotators are divided. The deep branch of the medial femoral circumflex artery (MFCA) provides the main blood supply to the femoral head. It is at greatest risk of iatrogenic injury if which of the following structures is released too close to its femoral insertion?

A surgeon is performing a modified Hardinge (direct lateral) approach for total hip arthroplasty. To prevent denervation of the anterior portion of the gluteus medius, the proximal split in the muscle should not extend beyond what distance from the tip of the greater trochanter?

During a posterior approach to the humerus for plate fixation of a midshaft fracture, the radial nerve is identified within the spiral groove. Which muscle head must be sharply split to expose the bone directly beneath the nerve in this region?

During a posterior approach to the hip, an artery is at risk of iatrogenic injury if the quadratus femoris is divided too far proximally. This artery typically courses between the quadratus femoris and which of the following structures?

A posterior approach (Kocher-Langenbeck) is utilized for an open reduction and internal fixation of a transverse acetabular fracture. The surgeon takes care to protect the primary blood supply to the femoral head. The primary vessel supplying the adult femoral head courses between which two muscles prior to piercing the posterior hip capsule?

A regional anesthesia team performs an adductor canal (Hunter's canal) block for postoperative analgesia following a total knee arthroplasty, aiming to spare quadriceps motor function. The target nerve provides sensory innervation to the medial lower leg. This nerve typically exits the adductor canal by piercing which of the following anatomic structures?

During a standard Kocher-Langenbeck (posterior) approach to the hip for an associated posterior wall acetabular fracture, the surgeon performs a tenotomy of the short external rotators. To protect the main blood supply to the femoral head, which of the following muscles should ideally remain intact because its tendon directly overlies and protects the deep branch of the medial femoral circumflex artery (MFCA)?

A 65-year-old woman sustains a displaced subcapital femoral neck fracture. The decision is made to perform a hemiarthroplasty due to the high risk of avascular necrosis. The predominant blood supply to the adult femoral head, which is disrupted in this injury, arises from the medial femoral circumflex artery (MFCA). The main branch of the MFCA supplying the femoral head is located between which two muscles before piercing the joint capsule?

A 7-year-old non-ambulatory child with spastic quadriplegic cerebral palsy presents for routine surveillance. AP pelvis radiographs reveal a Reimers migration percentage of 55% on the right hip with associated acetabular dysplasia. The hip is reducible on exam. What is the most appropriate surgical management?

A 7-year-old girl with spastic quadriplegic cerebral palsy has bilateral hip pain. Pelvic radiographs show bilateral hip subluxation with a Reimers migration percentage of 60%. What is the most appropriate surgical intervention?