3. Adult Reconstruction (Hip & Knee) MCQs

A 58-year-old female complains of localized anterior groin pain starting 6 months after a cementless total hip arthroplasty. The pain is exacerbated by straight leg raising and transitioning from a seated to a standing position. A diagnostic image-guided injection of anesthetic into the iliopsoas bursa provides complete temporary relief. Cross-sectional imaging is most likely to show which of the following?

A 62-year-old male undergoes revision shoulder arthroplasty for unexplained pain and subtle loosening 2 years after his primary surgery. Intraoperative cultures are taken. Fourteen days later, the lab reports growth of Cutibacterium (Propionibacterium) acnes. What are the microbiologic characteristics of this organism?

A 1-year-old presents with a short right lower limb and foot deformities. The image below is obtained during the initial evaluation to assess the overall limb. The clinical team suspects fibular deficiency.

Based on the comprehensive assessment principles outlined in the case, what is the MOST critical next step in accurately evaluating this child's limb length discrepancy and overall mechanical alignment?

Following neoadjuvant chemotherapy, the patient underwent restaging MRI, which demonstrated a reduction in peritumoral edema and no evidence of neurovascular encasement. Given the patient's age, skeletal maturity, and family preference, limb salvage with wide en bloc resection and modular distal femoral replacement was chosen. Which of the following factors was a primary reason *against* recommending a rotationplasty (Van Nes procedure) in this specific patient?

Which of the following surgical approaches to the hip carries the highest risk of injury to the superior gluteal nerve?

During a primary total knee arthroplasty, the surgeon notes the knee is balanced in extension but is tight in flexion. Which of the following steps is the most appropriate next maneuver to balance the knee?

A 55-year-old active male undergoes a total hip arthroplasty using a ceramic-on-ceramic bearing surface. Which of the following is the most commonly cited specific complication unique to this hard-on-hard bearing articulation?

A 65-year-old male presents with groin pain 4 years after a total hip arthroplasty utilizing a titanium stem and a 36-mm cobalt-chromium head. Inflammatory markers are normal, but metal ion levels (cobalt) are elevated. What is the most likely source of the elevated metal ions?

A 65-year-old female presents 1 year after a posterior-stabilized total knee arthroplasty with a painful catching sensation when extending her knee from a flexed position. What is the underlying etiology of this condition?

A 45-year-old male undergoes a total hip arthroplasty using a ceramic-on-ceramic bearing. At a 2-year follow-up, he complains of an audible squeaking noise with hip flexion but denies pain. Radiographs show a well-fixed implant. What is the most common cause of this phenomenon?

According to the Musculoskeletal Infection Society (MSIS) criteria, which of the following is considered a major criterion for diagnosing a periprosthetic joint infection (PJI)?

A 60-year-old male presents with an audible squeaking sound from his right hip, which underwent a ceramic-on-ceramic total hip arthroplasty 3 years ago. What biomechanical phenomenon is most frequently associated with squeaking in this specific bearing surface?

During a total knee arthroplasty (TKA), the surgeon inadvertently places the femoral component in excessive internal rotation. What is the most likely biomechanical consequence of this specific malpositioning?

Which of the following anatomic factors is most strongly associated with an increased risk of non-contact ACL ruptures in female athletes?

During the initial surgical debridement of a high-pressure injection injury to the ring finger, the surgeon needs to achieve wide exposure of the flexor tendon sheath, neurovascular bundles, and joint capsule while minimizing damage to critical structures and reducing the risk of secondary contractures. Based on the detailed surgical approach described in the case, which incision type is the most appropriate choice for this procedure?

A 68-year-old male undergoes a total hip arthroplasty (THA) for severe osteoarthritis. Postoperatively, he develops sudden onset severe hip pain and inability to bear weight. Radiographs show no obvious dislocation or fracture, but laboratory studies reveal an elevated ESR and CRP. Aspiration yields cloudy fluid with a white cell count of 80,000/µL and 90% neutrophils. Which of the following is the most appropriate next step in management?

A 75-year-old female with advanced Parkinson's disease falls and sustains a femoral neck fracture. She lives alone, is ambulating with a walker, and has a moderate cognitive impairment. Which of the following surgical options is generally preferred?

An 80-year-old patient undergoing rehabilitation after a total hip arthroplasty develops new onset of localized lower abdominal pain and tenderness at a previous laparoscopic cholecystectomy incision site. She reports being able to pass gas but has some difficulty with defecation. Examination reveals a subtle, firm, tender lump. Given her age and recent surgery, an occult Richter hernia should be considered.

What imaging modality would be most sensitive for initial diagnosis?

A 55-year-old female with severe rheumatoid arthritis is scheduled for an elective total hip arthroplasty. She takes methotrexate and adalimumab. According to the ACR/AAHKS guidelines, what is the most appropriate perioperative management of her medications?

A 65-year-old male undergoes a primary total hip arthroplasty. He has no personal or family history of venous thromboembolism (VTE). According to current clinical practice guidelines, which of the following is an acceptable strategy for postoperative VTE prophylaxis?