3. Adult Reconstruction (Hip & Knee) MCQs

A 55-year-old male who underwent a ceramic-on-ceramic total hip arthroplasty 2 years ago presents complaining of an audible squeaking sound during ambulation. Radiographs show secure components. Which of the following factors is most strongly associated with the development of this phenomenon?

A 65-year-old female presents with anterior knee pain and a painful catching sensation when actively extending her knee from 40 to 30 degrees of flexion. She underwent a posterior-stabilized total knee arthroplasty one year ago. What is the most likely underlying etiology of her symptoms?

A 68-year-old male with a metal-on-polyethylene total hip arthroplasty utilizing a large-diameter cobalt-chromium head presents with progressive groin pain. Radiographs show well-fixed components. Aspiration yields sterile, low-WBC fluid. MRI demonstrates a large pseudotumor. What is the primary pathophysiologic mechanism?

In kinematic alignment principles for total knee arthroplasty, the primary goal for orienting the femoral component is to align its transverse axis with which of the following native anatomical axes?

A patient experiences recurrent posterior dislocations of a total hip arthroplasty. CT evaluation reveals a combined anteversion (Widmer technique) of 15 degrees, with the acetabular cup at 5 degrees and the femoral stem at 10 degrees. What is the most appropriate revision strategy?

During a total knee arthroplasty for a severe, fixed valgus deformity, standard releases are performed. Which structure is typically tightest and may require targeted release to effectively balance the extension gap laterally?

An 80-year-old male sustains a fall resulting in a periprosthetic femur fracture around a previously asymptomatic THA.

Radiographs demonstrate a fracture pattern localized around the femoral stem. The stem exhibits obvious subsidence and loosening, but the proximal femoral bone stock remains adequate. What is the Vancouver classification and standard treatment?

If the femoral component in a total knee arthroplasty is inadvertently placed in excessive internal rotation relative to the surgical transepicondylar axis, what is the most likely biomechanical consequence?

In strictly controlled in-vitro simulator studies, which of the following bearing surface combinations demonstrates the lowest linear and volumetric wear rates per million cycles?

A patient with a midshaft femoral malunion presenting with 20 degrees of coronal varus requires a total knee arthroplasty. If standard intra-articular bone cuts perpendicular to the mechanical axis are performed without addressing the extra-articular deformity, what major intraoperative complication is most likely?

A surgeon decides to increase the femoral offset during a primary total hip arthroplasty (THA) using a high-offset femoral stem. Assuming leg length remains unchanged, what is the primary biomechanical effect of this modification?

A 65-year-old patient presents with a 'clunking' sensation and recurrent instability in deep flexion 2 years after a posterior-stabilized (PS) total knee arthroplasty (TKA). What is the most likely biomechanical cause of this cam-post jump phenomenon?

A 45-year-old man undergoes THA with a ceramic-on-ceramic (CoC) articulation. Postoperatively, he complains of a loud, high-pitched squeaking noise during gait. Which of the following component positions is most strongly associated with this phenomenon?

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

During trialing of a primary TKA, the surgeon notes that the knee is perfectly balanced and achieves full extension, but it is unacceptably tight in 90 degrees of flexion, preventing full range of motion. Which of the following is the most appropriate next step in management?

A 78-year-old woman presents with a periprosthetic femur fracture around her cemented THA stem after a fall. Radiographs demonstrate a spiral fracture at the tip of the stem with evidence of subsidence and a radiolucent mantle, but excellent proximal and distal bone stock. What is the most appropriate definitive management?

A patient presents with a painful catch and an audible 'clunk' as their knee approaches terminal active extension 1 year after a posterior-stabilized TKA. What is the pathomechanism of this specific complication?

Mechanically assisted crevice corrosion (MACC), or trunnionosis, has been identified as a cause of adverse local tissue reactions in non-metal-on-metal THA. Which combination of implant factors confers the highest risk for trunnionosis?

To minimize the risk of posterior dislocation following a primary THA, surgeons aim for an optimal 'combined anteversion' of the acetabular and femoral components. Based on classic principles, what is the generally accepted target range for combined anteversion?