3. Adult Reconstruction (Hip & Knee) MCQs

A 78-year-old woman sustains a fall 8 years after a cemented THA. Radiographs demonstrate a displaced periprosthetic fracture of the proximal femur that propagates around the tip of the stem. The stem is visibly subsided and grossly loose, but the proximal femoral bone stock remains adequate. According to the Vancouver classification, what is the most appropriate surgical treatment?

While trialing components during a primary TKA, the surgeon notes that the knee is symmetric and stable at 90 degrees of flexion, but it is symmetric and excessively loose in full extension. Which of the following intraoperative adjustments is the best step to balance the knee?

A 68-year-old man presents with thigh pain 15 years after an uncemented THA. Radiographs show significant eccentric wear of the polyethylene liner and massive expansile radiolucent lesions in the proximal femur. Which of the following cells is the primary mediator directly phagocytosing wear particles to initiate this pathologic cascade?

A 60-year-old man with a dual-mobility, metal-on-polyethylene THA presents with a large fluid collection around the hip and soft tissue necrosis, despite normal ESR and CRP levels. Aspiration shows a low cellularity fluid. This adverse local tissue reaction (ALTR) is most likely secondary to wear and corrosion at which interface?

Hip resurfacing arthroplasty preserves femoral bone stock but carries specific risks. Which of the following patients is universally considered to have a strict contraindication to metal-on-metal hip resurfacing?

A patient presents with anterior knee pain and a palpable, audible catch as the knee extends from 40 degrees of flexion to full extension, one year after a primary TKA. This complication (patellar clunk syndrome) is most classically associated with which type of implant design?

A 32-year-old man on chronic corticosteroids presents with severe groin pain. Radiographs of the hip are normal, but an MRI demonstrates an area of subchondral edema and a serpiginous line in the anterosuperior femoral head without subchondral collapse (Ficat Stage IIA). What is the most appropriate initial surgical intervention?

Following a primary THA, a patient complains that the operative leg feels significantly longer. Clinical examination and scanograms confirm a true 2 cm leg length discrepancy. Assuming the femoral neck osteotomy was performed perfectly according to preoperative templating, which intraoperative error most likely caused this outcome?

A surgeon is performing a TKA on a patient with a severe fixed valgus deformity. A lateral parapatellar approach is utilized. During gap balancing, the lateral extension gap remains excessively tight. Which of the following lateral structures is typically released first to balance the extension gap in a valgus knee?

A 65-year-old patient experiences recurrent posterior dislocations of their THA. CT imaging reveals the acetabular component is in 45 degrees of inclination and 0 degrees of anteversion, while the femoral stem is in 15 degrees of anteversion. What is the most appropriate surgical treatment?

An 82-year-old nursing home resident with multiple medical comorbidities develops a late chronic PJI of a TKA with Staphylococcus epidermidis. The implants are well-fixed, and the patient is deemed too high-risk for revision surgery. For chronic suppressive antibiotic therapy to be successful, which of the following criteria MUST be met?

A patient complains of a sensation of the knee "giving way" when descending stairs 6 months after a TKA. Clinical examination reveals the knee is perfectly stable to varus and valgus stress in full extension, but demonstrates significant laxity in varus and valgus at 90 degrees of flexion. Which of the following surgical errors is the most likely cause?

During the fixation of an uncemented acetabular cup in THA, the surgeon decides to place supplementary screws. According to the quadrant system described by Wasielewski, screw placement in the anteroinferior quadrant places which of the following vascular structures at greatest risk of direct injury?

Which of the following statements is true regarding Cutibacterium acnes in the context of periprosthetic shoulder infection?

A 16-year-old male is brought to the emergency department after a rugby tackle. He complains of severe chest pain and difficulty swallowing. Examination reveals a depression over the medial aspect of the left clavicle. A CT scan confirms a posterior sternoclavicular dislocation. What is the most appropriate next step in management?

A 78-year-old female sustains a periprosthetic femur fracture around a cemented total hip arthroplasty. Radiographs confirm a Vancouver B2 fracture pattern. What is the most appropriate surgical treatment?

A 45-year-old female undergoes closed reduction of a traumatic posterior hip dislocation. Post-reduction CT scan reveals concentric reduction but identifies a 6mm intra-articular osteochondral fragment within the fovea. She is neurologically intact. What is the most appropriate management?

The major blood supply to the proximal pole of the scaphoid enters the bone at which anatomical location?

The deep branch of the medial circumflex femoral artery (MCFA) provides the primary vascular supply to the adult femoral head. During a posterior approach to the hip, releasing which of the following short external rotators too close to the femur places this artery at greatest risk?

During a direct lateral (Hardinge) approach to the hip for arthroplasty, splitting the gluteus medius too proximally endangers the superior gluteal nerve. What is the generally accepted safe zone for splitting the gluteus medius proximal to the tip of the greater trochanter?