3. Adult Reconstruction (Hip & Knee) MCQs

Which of the following statements regarding synovial fluid C-reactive protein (CRP) in the diagnosis of PJI is most accurate?

A patient presents with a culture-negative PJI of the hip and a history of prolonged antibiotic use. You suspect a fungal infection. Which specific synovial fluid test is most appropriate to aid in diagnosing a Candida PJI?

According to the 2018 ICM, how do the diagnostic thresholds for synovial fluid WBC count and PMN percentage in an acute PJI (within 90 days of surgery) compare to those for chronic PJI?

Synovial fluid calprotectin has emerged as a biomarker for PJI. It is primarily released by which of the following cell types during a bacterial infection?

A patient with a metal-on-metal THA presents with pain and a large joint effusion. Aspiration yields thick, opaque fluid. Synovial WBC is 1,200 cells/uL with 90% monocytes/macrophages. Cultures are pending. Which of the following diagnoses is most likely?

During a Posterior-Stabilized (PS) Total Knee Arthroplasty (TKA), the cam and post mechanism is designed to substitute for the sacrificed posterior cruciate ligament (PCL). What is the primary kinematic function of the cam-post engagement during deep flexion?

A 58-year-old male with a metal-on-metal total hip arthroplasty presents with groin pain and a palpable cystic mass 5 years postoperatively. Aspiration yields sterile fluid. Histological examination of the periprosthetic tissue is most likely to reveal which of the following?

During a primary total knee arthroplasty for severe varus osteoarthritis, the surgeon finds the knee remains tight medially in both flexion and extension after performing initial bone cuts and removing osteophytes. Which structure should be released next in the standard sequence of medial soft tissue balancing?

Which bearing surface combination in Total Hip Arthroplasty (THA) is associated with the lowest volumetric wear rate but carries a specific risk of audible squeaking and catastrophic component fracture?

During a primary total knee arthroplasty (TKA), the surgeon notes that the knee is tight in flexion but balanced in extension. Which of the following surgical steps is most appropriate to balance the gaps?

According to the 2018 International Consensus Meeting criteria, which of the following findings is considered an absolute major criterion for the diagnosis of chronic periprosthetic joint infection?

Which of the following bearing surface combinations in total hip arthroplasty has the lowest volumetric wear rate but carries a unique risk of audible squeaking?

A 72-year-old female sustains a displaced femoral neck fracture after a mechanical fall. The surgeon opts for a hemiarthroplasty rather than internal fixation due to the high risk of avascular necrosis. The primary blood supply to the femoral head, which is disrupted in this injury, is a direct branch of which of the following arteries?

A 68-year-old male presents with a painful total knee arthroplasty 3 years after the index surgery. Joint aspiration yields a synovial fluid white blood cell count of 45,000 cells/uL with 92% polymorphonuclear neutrophils. What is the gold standard definitive management for this chronic periprosthetic joint infection?

During a primary total knee arthroplasty, the surgeon uses a measured resection and gap balancing technique. With the trial components in place, the knee is found to be tight in flexion but perfectly balanced in extension. Which of the following surgical adjustments will best correct this specific mismatch?

A 65-year-old male presents with a painful total hip arthroplasty 15 years after his index procedure. Radiographs show eccentric wear of the polyethylene liner and significant periprosthetic osteolysis. The primary biological mechanism driving this osteolysis is mediated by which of the following cell types phagocytosing wear debris?

A 45-year-old man with advanced ankylosing spondylitis undergoes bilateral total hip arthroplasty due to severe secondary osteoarthritis and autofusion. Which postoperative complication is he at significantly higher risk for compared to the general THA population?

A 40-year-old male with long-standing, severe ankylosing spondylitis is scheduled to undergo bilateral total hip arthroplasty for debilitating hip ankylosis. Postoperatively, this specific patient population is at a drastically increased risk for which of the following complications?

Which of the following describes the correct orientation for a standard posterior approach to the hip for total hip arthroplasty?

Which of the following is a recognized risk factor for the development of periprosthetic joint infection (PJI) following total hip arthroplasty?