3. Adult Reconstruction (Hip & Knee) MCQs

A 62-year-old male with a history of a metal-on-metal total hip arthroplasty presents with a painful, swollen hip. Aspiration yields sterile, thick, cloudy fluid.

The pathogenesis of this adverse local tissue reaction (ALTR) involves a hypersensitivity response mediated primarily by which of the following cell types?

A 32-year-old male sustains a displaced intracapsular femoral neck fracture. To understand the risk of avascular necrosis, an understanding of the adult femoral head blood supply is required.

The predominant blood supply to the weight-bearing dome of the femoral head in an adult arises from which of the following vessels?

During a primary total knee arthroplasty (TKA) using a measured resection technique, trial components are inserted. The surgeon notes that the knee is excessively tight in flexion but symmetrical and perfectly balanced in extension. Which of the following is the most appropriate next intraoperative step to balance the knee?

A 65-year-old male undergoes a revision total hip arthroplasty. Intraoperatively, extensive black metallic debris and tissue necrosis are found around the modular head-neck junction. Which of the following processes is primarily responsible for this finding?

When utilizing a cementless titanium component in total joint arthroplasty, optimizing the surface topography is critical for long-term biological fixation. What is the optimal pore size range required to promote maximal bone ingrowth?

A 55-year-old male underwent a total hip arthroplasty 3 years ago utilizing a ceramic-on-ceramic bearing surface

. He presents to the clinic complaining of a new, audible 'squeaking' sound originating from his hip when walking. What is the most common mechanical etiology for this phenomenon?

During a primary total knee arthroplasty (TKA) for a patient with a severe, fixed valgus deformity

, the surgeon employs an "inside-out" lateral release technique to balance the knee. In the classical stepwise sequence described for valgus release, which of the following structures is typically released first?

In total hip arthroplasty, aseptic loosening due to osteolysis is primarily driven by the biological reaction to wear debris. In a well-functioning, accurately aligned metal-on-polyethylene articulation, which specific mechanism of wear is predominantly responsible for generating the submicron polyethylene particles that trigger this cascade?

A new diagnostic biomarker is evaluated for the detection of periprosthetic joint infection (PJI). Out of 100 patients confirmed to not have PJI via gold-standard criteria, the new test correctly identifies 90 of them as negative. What statistical measure does this result (90%) directly represent?

A 65-year-old female experiences recurrent posterior dislocations following a primary total hip arthroplasty via a posterior approach. To optimize stability, what is the ideal orientation for the acetabular component according to Lewinnek's safe zone?

A 70-year-old male presents with a painful total knee arthroplasty 2 years post-operation. Joint aspiration reveals a synovial white blood cell (WBC) count of 4,500 cells/uL with 85% polymorphonuclear leukocytes (PMNs).

Based on MSIS criteria, what is the most appropriate definitive management?

In total hip arthroplasty, which bearing surface combination is associated with the lowest volumetric wear rate?

Following a displaced intracapsular femoral neck fracture, which artery provides the predominant residual blood supply to the femoral head?

During a posterior approach to the hip, protecting the deep branch of the medial femoral circumflex artery (MFCA) is critical to prevent avascular necrosis. Anatomically, this vessel consistently runs between which two muscles before entering the capsule?

Following a displaced subcapital femoral neck fracture, avascular necrosis frequently occurs due to the disruption of retinacular vessels. Which specific group of retinacular vessels provides the primary terminal blood supply to the weight-bearing dome of the femoral head?

A 75-year-old community-dwelling female sustains a non-displaced, valgus-impacted femoral neck fracture (Garden I). Which of the following is the most appropriate definitive management?

To significantly decrease the incidence of avascular necrosis (AVN) of the femoral head following a traumatic posterior hip dislocation, within what critical time frame should the hip be ideally reduced?

Which of the following arteries provides the predominant blood supply to the weight-bearing portion of the femoral head in an adult?

During a posterior approach to the hip, aggressive release of the quadratus femoris muscle insertion on the proximal femur puts which of the following vascular structures at greatest risk?