3. Adult Reconstruction (Hip & Knee) MCQs

A 55-year-old male with long-standing psoriatic arthritis is planning to undergo a total knee arthroplasty (TKA). Compared to a patient with primary osteoarthritis, this patient is at a significantly higher risk for which of the following postoperative complications?

A 42-year-old male presents with a chronic, slowly enlarging, painless knee effusion. An MRI is obtained.

Based on the most likely diagnosis, what is the definitive treatment of choice?

A 45-year-old male presents with chronic, painless swelling of the right knee without prior trauma. A sagittal T1-weighted MRI is shown below.

Which of the following is the most definitive and appropriate treatment for this condition?

A 42-year-old female with severe psoriatic arthritis presents with incapacitating pain, instability, and a 40-degree flexion deformity of her dominant index finger distal interphalangeal (DIP) joint. Radiographs show a classic "pencil-in-cup" deformity. If surgery is planned, which of the following is the most reliable procedure?

An 8-year-old boy with OI Type IV underwent bilateral femoral rodding with Fassier-Duval telescoping rods 4 years ago. He now presents with a 3 cm leg length discrepancy and recurrent bowing of the left femur. Radiographs show the left rod has failed to elongate, and the distal femur has grown past the end of the rod. What is the most appropriate management?

A 6-year-old non-ambulatory boy with SMA Type II is noted to have a painless, unilateral, chronic hip dislocation on routine surveillance radiographs. He sits comfortably in his custom wheelchair and has no difficulties with perineal hygiene. What is the most appropriate management of his hip dislocation?

A 6-year-old non-ambulatory male with Spinal Muscular Atrophy Type II is found to have a unilateral, chronic paralytic dislocation of the right hip during a routine radiographic screening. The patient is completely pain-free, has a supple range of motion, and sits comfortably in his custom-molded wheelchair. What is the most appropriate orthopedic management for this hip?

A 42-year-old female with a history of systemic sclerosis presents with severe pain and a non-healing ulcer on the tip of her index finger. Radiographs show resorption of the terminal phalangeal tuft. Which of the following autoantibodies is most strongly associated with this specific radiographic finding?

A 45-year-old female with systemic sclerosis (scleroderma) presents with chronic hand pain and fingertip ulcerations. Which of the following radiographic findings is most specifically associated with her condition?

A 65-year-old male presents with chronic pain in his total knee arthroplasty, performed 3 years ago. Aspiration yields 3,500 WBC/uL with 75% PMNs. Alpha-defensin is positive. Synovial CRP is elevated. According to the 2018 ICM criteria, what is the next best step in management?

A 45-year-old female with a history of systemic sclerosis presents with severe fingertip pain and recurrent ulceration. Radiographs of the hands are most likely to demonstrate which of the following pathognomonic findings?

A 65-year-old man presents with acute onset of right knee pain, swelling, and fever 3 weeks after a primary total knee arthroplasty. Aspiration yields a white blood cell count of 75,000 cells/uL with 92% neutrophils. The implant is well-fixed. What is the most appropriate surgical management?

A 45-year-old female presents with tightening of the skin on her fingers, dysphagia, and cold-induced digital vasospasm. Radiographs of her hands are most likely to demonstrate which of the following classic findings?

A 70-year-old man underwent a total hip arthroplasty 3 years ago. He had a dental extraction 4 weeks ago and now presents with 3 days of severe hip pain, erythema, and a temperature of 38.8°C. Aspiration yields 85,000 WBC/uL (95% neutrophils). What is the most appropriate initial surgical management?

Acro-osteolysis of the distal phalanges is frequently observed in patients with systemic sclerosis. Which of the following best describes the primary pathogenesis of this finding?

A 60-year-old female presents with severe hand deformities. Radiographs reveal prominent resorption of the terminal phalangeal tufts, preservation of the joint spaces, and diffuse subcutaneous calcifications. Marginal erosions are absent. This radiographic pattern is most pathognomonic for which of the following diseases?

A 54-year-old female with long-standing diffuse systemic sclerosis (scleroderma) presents with progressive, painful flexion contractures of her proximal and distal interphalangeal joints bilaterally. Radiographs show acro-osteolysis but no periarticular erosions. Which of the following is the most likely primary cause of her joint contractures?

During a total hip arthroplasty in a young adult with advanced Juvenile Idiopathic Arthritis (JIA), the surgeon must be prepared for which of the following common anatomic challenges?

A 5-year-old boy has unilateral pauciarticular juvenile idiopathic arthritis predominantly affecting his right knee. If left untreated, what is the most likely long-term effect on his lower extremities?