3. Adult Reconstruction (Hip & Knee) MCQs

A 55-year-old active male underwent a total hip arthroplasty using a ceramic-on-ceramic bearing. Two years postoperatively, he complains of a reproducible squeaking noise during walking, though he is pain-free. Which of the following factors is most strongly associated with this phenomenon?

During a primary total knee arthroplasty, the surgeon assesses the gaps after the initial bone cuts. The knee is perfectly balanced in full extension, but the joint is significantly tight in 90 degrees of flexion. Which of the following adjustments is the most appropriate next step?

A 58-year-old male presents with new-onset groin pain 5 years after an uncomplicated primary metal-on-polyethylene total hip arthroplasty. He has a 36-mm cobalt-chromium head on a titanium stem. Serum cobalt levels are significantly elevated out of proportion to chromium levels. Inflammatory markers are normal. What is the most likely diagnosis?

A 45-year-old active male underwent a total hip arthroplasty utilizing a ceramic-on-ceramic bearing. Two years later, he complains of an audible squeaking sound from the hip during deep flexion activities. Which of the following factors is most strongly associated with the development of this phenomenon?

A 62-year-old female reports a painful catching and popping sensation in her knee when rising from a chair, 14 months after receiving a posterior-stabilized total knee arthroplasty. The catch is consistently felt as the knee extends from 45 to 30 degrees of flexion. What is the most likely etiology of this patient's symptoms?

A 71-year-old male presents with an inability to perform a straight leg raise two years following a primary total knee arthroplasty. Imaging confirms a chronic, retracted rupture of the patellar tendon. The components are well-fixed and appropriately positioned. What is the most reliable surgical salvage option?

A surgeon is performing a primary total hip arthroplasty via the direct anterior approach utilizing the Hueter interval. Postoperatively, the patient complains of dysesthesia and numbness over the anterolateral aspect of the operative thigh. Which nerve was most likely injured during the superficial dissection?

A 75-year-old female with severe rheumatoid arthritis presents for a primary total knee arthroplasty. Clinical and radiographic evaluation demonstrates a severe valgus deformity with a completely incompetent, non-functional medial collateral ligament (MCL). Which of the following implant constraints is indicated?

A 68-year-old male with a prior long lumbar fusion (L2-pelvis) for degenerative scoliosis is planned for a primary total hip arthroplasty. He exhibits a stiff spinopelvic junction with a fixed pelvic retroversion (flatback deformity). How should the acetabular component positioning be modified to minimize the risk of anterior dislocation in extension?

Which of the following best describes the primary goal of the kinematic alignment philosophy in total knee arthroplasty compared to traditional mechanical alignment?

An 82-year-old female sustains a fall 8 years after an uncemented total hip arthroplasty. Radiographs reveal a periprosthetic femur fracture extending around the stem. The stem appears subsided and clinically loose, but there is adequate cortical bone stock in the proximal femur. According to the Vancouver classification, what is the most appropriate management?

A 59-year-old male is evaluated 8 weeks after a primary total knee arthroplasty. He complains of a stiff knee despite compliant physical therapy. His range of motion is 10 to 75 degrees. Inflammatory markers are normal, and radiographs show well-positioned components. What is the most appropriate next step in management?

A 65-year-old male complains of knee instability when descending stairs 1 year after a primary TKA. Examination reveals a knee that is fully stable in full extension but exhibits marked anteroposterior laxity in 90 degrees of flexion. Which of the following intraoperative technical errors most likely occurred?

A 55-year-old male presents with deep groin pain 6 years after a THA utilizing a metal-on-polyethylene bearing with a large diameter metal head. Labs demonstrate elevated serum cobalt and chromium levels. Aspiration yields cloudy fluid with a normal neutrophil count. What is the most likely cause of his symptoms?

During a primary TKA for a fixed valgus deformity of 20 degrees, the surgeon notes a tight lateral compartment in full extension, but the knee is well-balanced in 90 degrees of flexion. Which of the following structures is the primary tether and should be released to balance the gaps?

During templating for a primary THA, the surgeon notes a 15 mm leg length discrepancy (affected leg is short) and a highly offset native femur. If a standard offset stem is used instead of a high offset stem, what compensatory intraoperative error is most likely to occur in an attempt to restore soft tissue tension?

Which of the following statements best describes the primary biomechanical goal of kinematic alignment in total knee arthroplasty?

A 42-year-old highly active female undergoes THA using a ceramic-on-ceramic bearing. One year later, she complains of a loud, audible squeaking noise from the hip during specific movements, though she is pain-free. What is the most significant risk factor for this phenomenon?