3. Adult Reconstruction (Hip & Knee) MCQs

Two years after undergoing a total knee arthroplasty, a 65-year-old patient presents with a painful, swollen knee. Joint aspiration yields synovial fluid with a white blood cell count of 65,000/mcL (92% neutrophils). What is the gold-standard surgical management for this condition?

In total hip arthroplasty, which of the following bearing surface combinations is associated with the lowest linear wear rate but carries a specific risk of audible squeaking and catastrophic component fracture?

A 55-year-old woman presents with persistent groin pain and a palpable mass three years after a metal-on-metal total hip arthroplasty. Aspiration yields sterile, cloudy fluid. MRI demonstrates a large cystic periprosthetic collection. What is the most appropriate definitive management?

During a posterior-stabilized total knee arthroplasty, the surgeon notes that the knee is tight in flexion and well-balanced in extension. Which of the following intraoperative adjustments is most appropriate to balance the gaps?

A 65-year-old female undergoes a right total hip arthroplasty via a posterior approach. On postoperative day 1, she exhibits a profound right foot drop and inability to dorsiflex her great toe. A compressive hematoma has been ruled out by urgent MRI. What is the most appropriate management?

A highly active 70-year-old female who plays tennis three times a week sustains a displaced femoral neck fracture (Garden IV) after a ground-level fall. She has no significant medical comorbidities. Which of the following surgical options offers the best long-term functional outcome and lowest revision rate for this patient?

A 68-year-old male presents with severe knee pain and swelling two years after a primary total knee arthroplasty (TKA). Joint aspiration yields synovial fluid with a white blood cell count of 55,000 cells/mcL and 92% polymorphonuclear leukocytes (PMNs). What is the standard surgical management for this condition?

A 65-year-old man presents with progressive groin pain 5 years after an uncomplicated primary total hip arthroplasty utilizing a metal-on-polyethylene bearing. Serum cobalt levels are significantly elevated, while chromium levels are normal. Radiographs are unremarkable. What is the most likely cause of his symptoms?

During a primary total knee arthroplasty, trial components are inserted, and the surgeon notes the knee is tight in flexion but balanced and symmetric in extension. Which of the following adjustments is the most appropriate step to achieve balanced gaps?

A 70-year-old woman presents with recurrent posterior dislocations following a primary total hip arthroplasty performed via a posterior approach. Radiographic evaluation demonstrates an acetabular component in 5 degrees of retroversion and 45 degrees of abduction. The femoral stem is stable and placed in 15 degrees of anteversion. What is the most definitive surgical management?

A 65-year-old male is undergoing a Total Knee Arthroplasty (TKA). Intraoperatively, after making the standard bone cuts, the knee is tight in flexion but well-balanced in extension. Which of the following is the most appropriate next step to balance the knee?

A 65-year-old active male is undergoing a total hip arthroplasty. The surgeon chooses highly cross-linked polyethylene (HXLPE) instead of conventional polyethylene. Which of the following trade-offs is most directly associated with increasing the irradiation dose to create HXLPE?

During a total knee arthroplasty, trial components are placed. The knee is balanced in flexion, but is tight medially in extension. Which of the following releases is most appropriate to achieve a balanced gap?

A 68-year-old male undergoes a total hip arthroplasty. On postoperative day 3, he complains of sudden-onset pleuritic chest pain and dyspnea. His heart rate is 115 bpm, and oxygen saturation is 88% on room air. An ECG shows sinus tachycardia with an S1Q3T3 pattern. What is the most appropriate next step in management?

A 68-year-old female undergoes a primary total hip arthroplasty (THA) via a posterior approach for severe osteoarthritis. Six weeks postoperatively, she sustains a posterior dislocation of the THA while bending forward to tie her shoes. Recurrent posterior dislocations are most strongly associated with which of the following technical component malpositioning errors?

According to the Musculoskeletal Infection Society (MSIS) criteria, which of the following is considered a major definitive criterion for the diagnosis of a periprosthetic joint infection?

A 68-year-old man requires an elective total hip arthroplasty and is taking warfarin for a mechanical heart valve. He is bridged with therapeutic low-molecular-weight heparin (LMWH). To minimize the risk of epidural hematoma, when is the most appropriate time to administer the last dose of therapeutic LMWH prior to neuraxial anesthesia?

A new diagnostic immunoassay for periprosthetic joint infection is evaluated. If the prevalence of periprosthetic joint infection in the tested hospital population significantly increases over time, how are the positive predictive value (PPV) and negative predictive value (NPV) affected?

A 68-year-old man is scheduled for an elective total knee arthroplasty. He has a history of an uncomplicated myocardial infarction exactly 3 weeks ago and is currently asymptomatic. What is the best preoperative recommendation regarding his surgery timing?

A randomized controlled trial comparing two total knee arthroplasty designs concludes there is no significant difference in 10-year survivorship (p = 0.15). However, independent registry data later definitively proves a significant difference truly exists in the population. What statistical error occurred in the trial?