3. Adult Reconstruction (Hip & Knee) MCQs

A healthy 65-year-old man is scheduled for an elective THA for primary osteoarthritis. He has no personal or family history of venous thromboembolism. According to the AAOS clinical practice guidelines, which of the following regimens is highly utilized and acceptable for VTE prophylaxis in this patient?

During revision of a metal-on-metal THA for a symptomatic pseudotumor, tissue samples are sent for histopathology. Which of the following histologic findings is characteristic of an adverse local tissue reaction (ALTR/ALVAL) associated with this bearing surface?

A 60-year-old woman is 6 weeks post-primary THA. She complains her operative leg feels 1 cm longer. Clinical examination and standing radiographs confirm a 1 cm lengthening on the operative side. Her hip is completely stable. What is the most appropriate initial management?

A 72-year-old woman presents to the emergency department after a fall. Radiographs show a displaced fracture around the distal aspect of a cemented femoral stem placed 8 years ago. The cement mantle is fractured, and the stem has subsided 2 cm. What is the most appropriate management?

A 68-year-old man presents with progressive groin pain and a palpable mass 6 years after a metal-on-polyethylene total hip arthroplasty. Laboratory testing reveals normal ESR and CRP, but elevated serum cobalt levels with normal chromium levels. MRI demonstrates a large cystic fluid collection. What is the most likely etiology of his symptoms?

A 62-year-old woman is evaluated for a painful total hip arthroplasty. Hip aspiration yields synovial fluid with a WBC count of 2,800 cells/mcL and 60% polymorphonuclear cells. The synovial fluid alpha-defensin immunoassay is positive. Which of the following accurately describes the utility of the alpha-defensin test in this setting?

A 35-year-old woman with a history of chronic corticosteroid use presents with insidious onset of anterior hip pain. MRI reveals a well-demarcated subchondral lesion in the anterosuperior femoral head with a double-line sign on T2-weighted images, without evidence of subchondral collapse. What is the most appropriate initial surgical intervention?

A 70-year-old man underwent a primary right total hip arthroplasty via a direct lateral (Hardinge) approach. Postoperatively, he exhibits a pronounced Trendelenburg lurch and inability to actively abduct the right hip against gravity. Injury to which of the following structures most likely occurred during the surgical exposure?

A 42-year-old woman with advanced primary osteoarthritis of the hip desires a metal-on-metal hip resurfacing arthroplasty to maintain her high-impact athletic lifestyle. Which of the following patient factors represents an absolute contraindication to this specific procedure?

Increasing femoral offset during total hip arthroplasty, without altering leg length, results in which of the following biomechanical changes?

A 62-year-old man presents with progressive groin pain 5 years after receiving a metal-on-polyethylene total hip arthroplasty. Laboratory tests reveal a serum cobalt level of 12 ppb and a normal serum chromium level. Inflammatory markers are normal. What is the most likely etiology?

A 70-year-old woman with a T10-to-pelvis posterior spinal fusion undergoes a total hip arthroplasty. Because of her spinal fusion, her pelvis is unable to tilt posteriorly when she transitions from standing to sitting. To minimize the risk of posterior dislocation, how should the acetabular component positioning be adjusted?

A 78-year-old woman sustains a periprosthetic femur fracture around a cemented femoral stem. Radiographs demonstrate a fracture at the tip of the stem with evidence of cement mantle fracture and stem subsidence. The distal bone stock is adequate. According to the Vancouver classification, what is the most appropriate management?

A 55-year-old woman presents with hip pain and a palpable groin mass 6 years after a metal-on-metal hip resurfacing. Histologic examination of the periarticular tissue is most likely to reveal which of the following predominant features?

A 45-year-old highly active man underwent a ceramic-on-ceramic total hip arthroplasty 3 years ago. He now complains of a loud squeaking noise from the hip when bending and walking, without significant pain. What is the most likely biomechanical cause of this phenomenon?

Increasing the femoral offset in total hip arthroplasty results in which of the following biomechanical changes?

A 72-year-old male presents with a periprosthetic femur fracture around a cemented femoral stem 10 years post-THA. Radiographs show a fracture extending from the lesser trochanter to the distal tip of the stem, with a radiographically loose stem and poor bone stock. What is the most appropriate management?

According to the 2018 International Consensus Meeting criteria, which of the following is considered a major criterion, diagnostic in itself, for periprosthetic joint infection (PJI)?

A 35-year-old male with a history of systemic lupus erythematosus treated with corticosteroids presents with groin pain. An MRI confirms stage II osteonecrosis of the right femoral head with no evidence of subchondral collapse. He has a 30% involvement of the weight-bearing portion. Which is the most appropriate initial surgical intervention?

Ceramic-on-ceramic (CoC) bearing surfaces in total hip arthroplasty are characterized by which of the following compared to metal-on-polyethylene?