3. Adult Reconstruction (Hip & Knee) MCQs

During a posterior approach to the hip (Kocher-Langenbeck), which two muscles form the interval where the deep branch of the medial circumflex femoral artery is most at risk?

A 50-year-old moderately active female feels a 'pop' in her posterior knee while squatting. An MRI is obtained as seen in the figure.

It demonstrates a medial meniscus posterior root tear with 4 mm of extrusion and minimal osteoarthritis. What is the most appropriate surgical management?

A 50-year-old active man presents with acute medial joint line pain after a deep squat. MRI reveals a medial meniscus posterior root tear with 3 mm of extrusion. To prevent rapid joint degeneration, which of the following is the most appropriate management?

A 9-year-old girl with a history of right femoral shaft fracture treated non-operatively now has a 3 cm leg length discrepancy. According to the multiplier method, which of the following data points is strictly required to predict her discrepancy at skeletal maturity?

A 10-year-old girl is evaluated for a leg length discrepancy following a distal femoral physeal fracture 2 years ago. A scanogram reveals the injured limb is 3 cm shorter than the normal limb. Based on the multiplier method, her predicted leg length discrepancy at maturity is 4.5 cm. Which of the following is the most appropriate surgical management plan?

Figure 14 shows the radiograph of an 80-year-old male presenting with thigh pain. Radiographs demonstrate a periprosthetic fracture around a loose femoral stem with poor proximal bone stock. What is the most appropriate management?

A 35-year-old active male is undergoing total hip arthroplasty. A ceramic-on-ceramic bearing is chosen. Which of the following is a known specific complication associated with this bearing surface compared to metal-on-polyethylene?

Figure 4 displays the MRI of a 40-year-old patient with groin pain and normal plain radiographs. What is the most appropriate initial surgical intervention for early-stage pre-collapse avascular necrosis of the femoral head?

According to Lewinnek, what is the target safe zone for acetabular component positioning to minimize the risk of dislocation in total hip arthroplasty?

A 65-year-old man presents with groin pain 5 years after undergoing a primary total hip arthroplasty with a metal-on-polyethylene bearing. Serum metal ion testing reveals an isolated elevation of cobalt levels with normal chromium levels. Metal artifact reduction sequence (MARS) MRI shows a fluid collection around the hip. What is the most likely diagnosis?

A 78-year-old woman sustains a periprosthetic femur fracture around a cementless tapered wedge stem. Radiographs show a spiral fracture around the tip of the stem with 2 cm of implant subsidence, but excellent bone stock remains in the proximal femur. According to the Vancouver classification, what is the most appropriate management?

A 68-year-old patient with a prior L3-pelvis spinal fusion for adult spinal deformity undergoes primary total hip arthroplasty (THA). Because of spinopelvic stiffness, the patient's pelvis fails to appropriately retrovert when moving from a standing to a sitting position. If standard "safe zone" cup positioning is used, what is the most likely complication during sitting?

A 74-year-old female sustains a fall and presents with thigh pain. Radiographs demonstrate a fracture around a cemented femoral stem. The stem is radiographically loose, but the proximal femur has good bone stock with an intact calcar. According to the Vancouver classification, what is the most appropriate surgical management?

A 55-year-old male with a ceramic-on-ceramic total hip arthroplasty complains of a new-onset, audible squeaking from his hip when walking. Radiographs show the acetabular component is placed in 60 degrees of inclination. Which of the following is the most likely biomechanical cause of this symptom?

When performing a direct anterior approach (DAA) for total hip arthroplasty, the surgeon utilizes an internervous and intermuscular plane. Which of the following correctly describes the superficial surgical interval for this approach?

A 62-year-old female with a metal-on-polyethylene total hip arthroplasty presents with a large, painful cystic mass in her groin. Laboratory testing reveals markedly elevated serum cobalt levels and normal serum chromium levels. Radiographs show a well-fixed cup and stem. What is the most likely diagnosis?

The sciatic nerve is the most commonly injured nerve during total hip arthroplasty, particularly during lengthening for developmental dysplasia. Which portion of the nerve is most susceptible to stretch injury, and why?

A 32-year-old patient on chronic corticosteroid therapy presents with deep groin pain. MRI reveals a focal, well-circumscribed anterosuperior necrotic lesion in the femoral head. There is no evidence of subchondral collapse or joint space narrowing on radiographs or MRI. Which of the following is the most appropriate joint-preserving surgical intervention?

A 66-year-old female presents with chronic lateral hip pain and a severe Trendelenburg lurch. Corticosteroid injections have provided no relief. Radiographs show no evidence of osteoarthritis. MRI reveals a full-thickness tear of the gluteus medius tendon with minimal fatty infiltration of the muscle belly. What is the most appropriate management?