3. Adult Reconstruction (Hip & Knee) MCQs

During a total knee arthroplasty (TKA), the surgeon inadvertently places the femoral component in excessive internal rotation. What is the most likely clinical consequence of this error?

A 70-year-old male develops a prosthetic joint infection 3 weeks after a total hip arthroplasty. Which of the following organisms is most commonly responsible for acute, early post-operative infections?

A 68-year-old female complains of a painful catch at 40 degrees of flexion when extending her knee, 1 year after a posterior-stabilized total knee arthroplasty (TKA). What is the underlying pathophysiology of her symptoms?

A 70-year-old female with advanced, medication-refractory rheumatoid arthritis undergoes a primary semi-constrained (linked) total elbow arthroplasty (TEA). To prevent mechanical failure and aseptic loosening, she must be counseled to strictly observe which of the following lifetime weight-lifting restrictions for the operative arm?

A 19-year-old male presents to the emergency department after being tackled in a rugby match. He complains of severe medial chest pain, shortness of breath, and difficulty swallowing. Physical examination reveals a palpable depression at the medial end of the right clavicle. An urgent chest CT confirms a posterior sternoclavicular dislocation. What is the most appropriate next step in management?

A 65-year-old female with advanced rheumatoid arthritis undergoes an uncomplicated linked total elbow arthroplasty (TEA). Postoperatively, she must be counseled regarding permanent lifting restrictions to prevent aseptic loosening. What is the generally accepted maximum lifetime weight-lifting limit for a single arm after TEA?

During a posterior-stabilized total knee arthroplasty, the surgeon achieves equal and symmetric medial and lateral gaps in extension. However, upon flexing the knee to 90 degrees, the joint is symmetrically too tight to accept the trial polyethylene insert. Which of the following is the most appropriate next step to balance the knee?

A 68-year-old woman is evaluated 4 weeks after an uncomplicated primary total hip arthroplasty via a posterior approach. She complains of new-onset foot drop. On exam, she has weakness in ankle dorsiflexion and eversion, but inversion and plantarflexion are normal. Which of the following surgical factors most likely contributed to this specific neurological deficit?

Ceramic-on-ceramic (CoC) bearing surfaces in total hip arthroplasty offer excellent wear characteristics but come with specific complications. Which of the following is a recognized unique complication associated specifically with CoC articulations?

A 55-year-old active male underwent a total hip arthroplasty (THA) 2 years ago and now complains of a high-pitched squeaking noise coming from his hip when he bends forward. He denies pain. Which of the following bearing surface combinations was most likely used?

In posterior cruciate substituting (PS) total knee arthroplasty (TKA), the implant design utilizes a cam on the femoral component and a post on the tibial polyethylene. The primary mechanical purpose of this cam-post engagement is to induce which of the following kinematic motions?

A 65-year-old female presents with a painful popping sensation over the anterior knee when extending from a flexed position, 18 months after a primary total knee arthroplasty. What implant design and specific complication are most likely associated with her clinical presentation?

During a primary total knee arthroplasty in a patient with a fixed 20-degree valgus deformity, the surgeon notes a tight lateral extension gap. If a sequential lateral release is utilized to balance the knee in extension, which of the following structures is typically released first?

In the setting of revision total hip arthroplasty for recurrent posterior instability in a patient with deficient abductors, a dual mobility cup is chosen. What is the primary biomechanical advantage of a dual mobility construct in preventing dislocation?

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

A 62-year-old male with a metal-on-metal total hip arthroplasty presents with groin pain and a palpable anterior thigh mass. Aspiration is negative for infection. Tissue biopsy demonstrates an Adverse Local Tissue Reaction (ALVAL). Which histological finding is a hallmark of this condition?

A 60-year-old male who underwent a primary total hip arthroplasty (THA) with a ceramic-on-ceramic bearing surface two years ago presents with a loud, high-pitched squeaking noise coming from his hip during certain movements, particularly bending and rising from a chair. Which of the following is the most significant biomechanical risk factor for developing squeaking in this type of bearing?

A 72-year-old diabetic male develops a chronic periprosthetic joint infection of his knee. Cultures yield Methicillin-Resistant Staphylococcus aureus (MRSA). The resistance of this organism to beta-lactam antibiotics (e.g., oxacillin, methicillin, cephalosporins) is primarily mediated by the expression of the mecA gene. What is the direct functional consequence of the mecA gene product?

During a total knee arthroplasty (TKA) on a patient with a severe, fixed valgus deformity, the surgeon notes that the extension gap remains unacceptably tight on the lateral side after initial bony cuts. To balance the knee, a stepwise lateral soft tissue release is planned. Which of the following structures is considered the primary restraint to valgus stress in extension, and is typically released to open a tight lateral extension gap without affecting the flexion gap?