3. Adult Reconstruction (Hip & Knee) MCQs

A 65-year-old man is scheduled for an elective total hip arthroplasty under spinal anesthesia. He is receiving prophylactic doses of low-molecular-weight heparin (LMWH). According to current guidelines, how long before the spinal block should the last dose of LMWH be administered?

A 70-year-old male with severe COPD is being evaluated preoperatively for a total knee arthroplasty. Which pulmonary function test parameter is considered the strongest predictor of significant postoperative pulmonary complications?

A 65-year-old woman undergoes an uncomplicated elective total hip arthroplasty. According to major societal guidelines (AAOS/ACCP), what is the minimum recommended duration for pharmacologic venous thromboembolism (VTE) prophylaxis postoperatively?

A 68-year-old woman on postoperative day 3 following a total knee arthroplasty presents with sudden onset dyspnea, tachypnea, and pleuritic chest pain. ECG shows sinus tachycardia and an S1Q3T3 pattern. What is the most appropriate initial diagnostic study to confirm the suspected diagnosis?

During a revision total hip arthroplasty for recurrent posterior instability, the surgeon notes that the existing acetabular component is well-fixed but positioned in 0 degrees of anteversion. The femoral component is well-fixed with 15 degrees of anteversion. What is the most appropriate management?

In a patient undergoing revision total hip arthroplasty (THA) for aseptic loosening, the presence of particulate polyethylene debris is noted. What is the primary biological mechanism mediating the resulting osteolysis?

In total hip arthroplasty, which bearing surface combination offers the lowest linear wear rate but carries a risk of squeaking and catastrophic fracture?

A 78-year-old woman with a history of a primary total hip arthroplasty (THA) 10 years ago presents with her third posterior dislocation in the past 6 months. Radiographs and CT show well-fixed components with appropriate anteversion and inclination. Intraoperative assessment reveals severely deficient abductor musculature. Which of the following surgical options is most appropriate?

In total hip arthroplasty, which of the following bearing surface combinations offers the lowest wear rate but the highest risk of catastrophic failure from brittle fracture?

A 65-year-old female undergoes total hip arthroplasty. During the informed consent, she asks about the lowest wear rate among bearing surfaces. Which of the following bearing surface combinations offers the lowest volumetric wear rate?

When performing a total knee arthroplasty, balancing the flexion and extension gaps is critical. If the extension gap is tight but the flexion gap is well-balanced, which of the following steps is the most appropriate next action?

A 45-year-old man with long-standing Ankylosing Spondylitis presents for pre-operative evaluation before a total hip arthroplasty. Which of the following pulmonary function test patterns is most characteristic of his systemic disease?

According to the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines, which of the following is an acceptable primary pharmacologic agent for the prevention of symptomatic pulmonary embolism following elective total knee arthroplasty in a standard-risk patient?

A 65-year-old woman undergoes a total hip arthroplasty (THA) via a posterior approach. Postoperatively, she suffers recurrent posterior dislocations. Radiographs reveal the acetabular cup is placed in 30 degrees of inclination and 5 degrees of retroversion. Which surgical adjustment is most appropriate to stabilize the joint?

A 68-year-old woman presents with her third posterior dislocation of a total hip arthroplasty (THA) performed 6 weeks ago via a posterior approach. Radiographs demonstrate well-fixed components with the acetabular cup in 45 degrees of abduction and 0 degrees of anteversion. What is the most likely primary cause of her recurrent instability?

A 60-year-old female undergoes a total hip arthroplasty. During cement pressurization and insertion of the femoral stem, she experiences a sudden drop in end-tidal CO2 and oxygen saturation, accompanied by hypotension. Which of the following is the primary pathophysiological mechanism for this event?

A 72-year-old woman undergoes a posterior approach total hip arthroplasty for severe osteoarthritis. Postoperatively, she is noted to have a foot drop, weak ankle dorsiflexion, and decreased sensation over the first web space. Which nerve was most likely injured intraoperatively?

A 68-year-old female presents with progressive groin pain 12 years after a cementless total hip arthroplasty. Radiographs reveal significant eccentric wear of the polyethylene liner and periprosthetic osteolysis. What particle size of polyethylene wear debris is most biologically active in initiating this macrophage-mediated response?

A 40-year-old male with a history of chronic systemic corticosteroid use presents with progressive hip pain. MRI reveals a crescent sign in the anterosuperior aspect of the femoral head, without subchondral collapse (Ficat Stage II). What is the most appropriate joint-preserving surgical intervention?