3. Adult Reconstruction (Hip & Knee) MCQs

A patient develops anterolateral thigh numbness following a direct anterior approach to the hip. The injured nerve typically exits the pelvis in which relation to the ASIS?

During the posterior approach to the hip for a total hip arthroplasty, the short external rotators are divided. To protect the primary blood supply to the femoral head in a joint-preserving procedure (e.g., surgical hip dislocation), the surgeon must understand the course of the medial circumflex femoral artery (MCFA). The deep branch of the MCFA passes consistently between which two muscles?

A 45-year-old patient sustains a displaced femoral neck fracture. To counsel the patient regarding the risk of avascular necrosis, the surgeon considers the vascular anatomy. Which artery provides the primary blood supply to the weight-bearing portion of the adult femoral head?

A patient undergoes a regional block in the adductor canal (Hunter's canal) for postoperative pain control following a total knee arthroplasty. Which of the following muscles forms the anterolateral boundary of this anatomical canal?

Avascular necrosis of the scaphoid proximal pole is a well-known complication of scaphoid waist fractures. This occurs due to the retrograde intraosseous blood supply of the scaphoid, with the major blood vessels entering at which anatomic location?

A 7-year-old boy with Ellis-van Creveld syndrome requires surgical intervention for bilateral severe genu valgum with lateral patellar tracking. Which surgical strategy is most appropriate to correct the deformity while addressing the underlying pathoanatomy?

A 70-year-old male with widespread Paget's disease is scheduled for a total hip arthroplasty due to severe secondary osteoarthritis. Which of the following is a major intraoperative and perioperative anesthetic concern specific to his underlying bone disease?

When performing a total knee arthroplasty in a patient with advanced Paget's disease of the tibia, which of the following statements regarding the expected surgical outcome and technical considerations is most accurate?

A girl with a 3 cm right leg length discrepancy (LLD) has a skeletal bone age of 11 years. Assuming skeletal maturity at age 14, what is the most appropriate management to achieve limb equality at maturity based on the Menelaus method?

An 8-year-old girl has a predicted leg length discrepancy of 3.5 cm at maturity due to a prior distal femoral physeal fracture. What is the most appropriate definitive management?

When planning a distal femoral corrective osteotomy, understanding the relationship between the mechanical and anatomic axes of the femur is critical. In a normal femur, the angle between the anatomic and mechanical axes (AMA angle) typically measures:

An 11-year-old girl with a skeletal age of 11 presents with a projected leg length discrepancy (LLD) of 3 cm. Assuming standard growth rates, how much length correction can be anticipated if a contralateral distal femoral epiphysiodesis is performed today?

A patient presents with a projected leg length discrepancy at maturity of 1.5 cm due to a mild congenital hemihypertrophy. What is the most appropriate management recommendation?

A 40-year-old patient presents with a symptomatic valgus deformity of 15 degrees originating entirely within the distal femur. To restore the mechanical axis while avoiding leg length discrepancy, which procedure is mechanically most sound if lengthening is strictly avoided?

A patient with a 4 cm structural right leg length discrepancy stands barefoot. To maintain truncal balance and visual gaze, which compensatory mechanism is primarily utilized by the pelvis and hips?

A 3-week-old infant presents with fever, irritability, and pseudoparalysis of the right leg. Ultrasound confirms a large hip effusion.

If surgical drainage is delayed, what is the most severe and irreversible complication according to the Choi classification?

A 65-year-old female presents for her 6-week postoperative visit following a right total hip arthroplasty. She complains of a persistent limp. On physical examination, she demonstrates a positive Trendelenburg sign on the right. Radiographs reveal that the femoral offset of the right hip is 10 mm less than the contralateral, native left hip. Which of the following biomechanical consequences is most likely to occur as a direct result of this decreased femoral offset?

A 45-year-old highly active male underwent a total hip arthroplasty utilizing a ceramic-on-ceramic bearing surface. Two years postoperatively, he presents complaining of an audible squeaking sound coming from his hip when he walks, particularly when bending or taking long strides. Radiographs show well-fixed components. Which of the following factors is most strongly associated with the development of this specific complication?

A 62-year-old female presents with groin pain one year after an uncomplicated primary total hip arthroplasty. The pain is exacerbated when she actively lifts her leg to get into a car or bed. On examination, resisted active hip flexion reproduces her anterior groin pain. Radiographs demonstrate an uncemented acetabular component with 5 mm of anterior overhang relative to the anterior column. What is the most appropriate initial management for this patient?