Hip & Knee 2015 Flashcards
- When performing total hip arthroplasty, what is the traditionally accepted acetabular component’s ideal position or “safe zone” within which risk for dislocation is minimized?
- 20 to 40 degrees of abduction and 0 to 20 degrees of anteversion
- 25 to 45 degrees of abduction and 0 to 20 degrees of anteversion
- 25 to 45 degrees of abduction and 5 to 25 degrees of anteversion
- 30 to 50 degrees of abduction and 5 to 25 degrees of anteversion
- 35 to 55 degrees of abduction and 10 to 35 degrees of anteversion
- 30 to 50 degrees of abduction and 5 to 25 degrees of anteversion
RECOMMENDED READINGS
Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978 Mar;60(2):217-20. PubMed PMID: 641088.
Barrack RL, Krempec JA, Clohisy JC, McDonald DJ, Ricci WM, Ruh EL, Nunley RM. Accuracy of acetabular component position in hip arthroplasty. J Bone Joint Surg Am. 2013 Oct 2;95(19):1760-8. doi: 10.2106/JBJS.L.01704. PubMed PMID: 24088968.
Liu F, Gross TP. A safe zone for acetabular component position in metal-on-metal hip resurfacing arthroplasty: winner of the 2012 HAP PAUL award. J Arthroplasty. 2013 Aug;28(7):1224-30. doi: 10.1016/j.arth.2013.02.033. Epub 2013 Mar 26. PubMed PMID: 23540536.
- Which mode of corrosion best describes the likely failure mechanism shown in Figure 20?
- Pitting
- Fretting
- Crevice
- Galvanic
- Intergranular
- Fretting
- Figures 30a through 30c are the radiograph and CT scans of a 70-year-old woman who has persistent groin and lateral hip pain 6 months after undergoing open reduction and internal fixation (ORIF) of a hip fracture. Physical therapy, topical and oral nonsteroidal anti-inflammatory drugs, and activity modification have not provided relief. She had temporary but incomplete relief of her lateral-sided pain after receiving a trochanteric bursal injection, but she now uses a cane. What is the best treatment option?
- Total hip arthroplasty (THA)
- Open bursectomy
- Bone grafting and revision ORIF
- Hardware removal
- Valgus intertrochanteric osteotomy
- Total hip arthroplasty (THA)
RECOMMENDED READINGS
Yang JJ, Lin LC, Chao KH, Chuang SY, Wu CC, Yeh TT, Lian YT. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. J Bone Joint Surg Am. 2013 Jan 2;95(1):61-9. doi:10.2106/ JBJS.K.01081. PubMed PMID: 23283374.
Archibeck MJ, Carothers JT, Tripuraneni KR, White RE Jr. Total hip arthroplasty after failed internal fixation of proximal femoral fractures. J Arthroplasty. 2013 Jan;28(1):168-71. doi: 10.1016/j. arth.2012.04.003. Epub 2012 Jun 6. PubMed PMID: 22682040.
- When performing total knee arthroplasty on the patient whose radiographs are shown in Figures 44a and 44b, particular attention should be directed toward avoiding which intraoperative femoral component placement error?
- Flexion
- Oversize
- Undersize
- Internal rotation
- External rotation
- Internal rotation
RECOMMENDED READINGS
Miller MC, Berger RA, Petrella AJ, Karmas A, Rubash HE. Optimizing femoral component rotation in total knee arthroplasty. Clin Orthop Relat Res. 2001 Nov;(392):38-45. PubMed PMID: 11716411.
Steinberg ME, Bands RE, Parry S, Hoffman E, Chan T, Hartman KM. Does lesion size affect the outcome in avascular necrosis? Clin Orthop Relat Res. 1999 Oct;(367):262-71. PubMed PMID: 10546624.
Victor J. Rotational alignment of the distal femur: a literature review. Orthop Traumatol Surg Res. 2009 Sep;95(5):365-72. doi: 10.1016/j.otsr.2009.04.011. Epub 2009 Jul 9. Review. PubMed PMID: 19592323.
Pagnano MW, Hanssen AD. Varus tibial joint line obliquity: a potential cause of femoral component malrotation. Clin Orthop Relat Res. 2001 Nov;(392):68-74. PubMed PMID: 11716427.
- Figures 50a and 50b are the MR images of a 40-year-old man who has left hip pain. He has a history of steroid use. When using the modified Kerboul method, angle degree exceeding which measure is associated with high risk for progression to femoral head collapse?
- 150 degrees
- 190 degrees
- 220 degrees
- 240 degrees
- 270 degrees
- 240 degrees
RECOMMENDED READINGS
Glassman AH, Lachiewicz PF, Tanzer M, eds. Orthopaedic Knowledge Update: Hip and Knee Reconstruction. 4th ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2011.
Ha YC, Jung WH, Kim JR, Seong NH, Kim SY, Koo KH. Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg Am. 2006 Nov;88 Suppl 3:35-40. PubMed PMID: 17079365.
- A 58-year-old healthy woman had hip arthroplasty 3 years ago with a recalled modular stem and metal-on-metal articulation. She continued to have hip pain following her surgery. Her cobalt and chromium ion levels are elevated, but her C-reactive protein level and erythrocyte sedimentation rate are within defined limits. A small fluid collection is seen around the hip on metal artifact reduction sequence MRI. At the time of revision, there was a large amount of cloudy fluid around the hip joint. Her cell count is 1000/mm3 with 45% nucleated cells (by manual count). The femoral and acetabular components are in good position and are well fixed to the bone. There is evidence of taper corrosion. What is the most appropriate next step?
- Remove all components and place the cement spacer.
- Remove all components and revise the femur and acetabulum.
- Retain the components and place a new femoral head and acetabular liner.
- Revise the femoral component and acetabular liner.
- Close the wound and await culture results before proceeding with the revision.
- Revise the femoral component and acetabular liner.
RECOMMENDED READINGS
Goyal N, Ho H, Fricka KB, Engh CA Jr. Do you have to remove a corroded femoral stem? J Arthroplasty. 2014 Sep;29(9 Suppl):139-42. doi: 10.1016/j.arth.2014.03.055. Epub 2014 May 27. PubMed PMID: 24973927.
Pivec R, Meneghini RM, Hozack WJ, Westrich GH, Mont MA. Modular taper junction corrosion and failure: how to approach a recalled total hip arthroplasty implant. J Arthroplasty. 2014 Jan;29(1):1-6. doi: 10.1016/j.arth.2013.08.026. Epub 2013 Sep 30. Review. PubMed PMID: 24090661.
Wyles CC, Larson DR, Houdek MT, Sierra RJ, Trousdale RT. Utility of synovial fluid aspirations in failed metal-on-metal total hip arthroplasty. J Arthroplasty. 2013 May;28(5):818-23. doi: 10.1016/j. arth.2012.11.006. Epub 2013 Mar 15. PubMed PMID: 23499404.
- A 125-pound, 65-year-old woman fell from a height and sustained an isolated displaced femoral shaft fracture. There is concern for hemorrhage because she also has chronic anemia. What is the average estimated adult blood loss when such an injury occurs?
- 250 cc
- 500 cc
- 1250 cc
- 2250 cc
- 3250 cc
- 1250 cc
RECOMMENDED READINGS
Lieurance R, Benjamin JB, Rappaport WD. Blood loss and transfusion in patients with isolated femur fractures. J Orthop Trauma. 1992;6(2):175-9. PubMed PMID: 1602337.
Lee C, Porter KM. Prehospital management of lower limb fractures. Emerg Med J. 2005 Sep;22(9):660-3. Review. PubMed PMID: 16113195.
- A 64-year-old Jehovah’s witness has end-stage hip arthritis. The decision is made to proceed with total hip arthroplasty. Which intervention will most effectively reduce potential for postoperative anemia and subsequent transfusion?
- General anesthesia
- Bipolar sealer electrocautery
- Preoperative iron supplementation
- Hypotensive epidural/spinal anesthesia
- Local skin infiltration with anesthetic/epinephrine
- Hypotensive epidural/spinal anesthesia
RECOMMENDED READINGS
Moonen AF, Neal TD, Pilot P. Peri-operative blood management in elective orthopaedic surgery. A critical review of the literature. Injury. 2006 Dec;37 Suppl 5:S11-6. Review. Erratum in: Injury. 2007 Oct;38(10):1224. PubMed PMID: 17338906.
Morris MJ, Barrett M, Lombardi AV Jr, Tucker TL, Berend KR. Randomized blinded study comparing a bipolar sealer and standard electrocautery in reducing transfusion requirements in anterior supine intermuscular total hip arthroplasty. J Arthroplasty. 2013 Oct;28(9):1614-7. doi: 10.1016/j. arth.2013.01.032. Epub 2013 Mar 16. PubMed PMID: 23507071.
- Figures 108a through 108c are the radiographs and clinical photograph of a 50-year-old woman who underwent uncomplicated total knee arthroplasty 1 year ago. She was never satisfied with the results of her surgery. She fell at home and was admitted to the hospital with severe knee pain. Her medical issues include atrial fibrillation, vascular insufficiency, and obesity. Her C-reactive protein level and erythrocyte sedimentation rate are elevated. Knee aspiration reveals a bloody effusion, and a cell count could not be obtained. Cultures show no growth after 2 days. What is the most appropriate next step?
- 2-component revision
- Revision of the tibial component only
- Removal of the components and placement of a cement spacer
- Knee immobilizer, limited weight bearing, and delayed revision after her skin
quality improves
- Knee fusion
- Removal of the components and placement of a cement spacer
RECOMMENDED READINGS
Watts CD, Wagner ER, Houdek MT, Osmon DR, Hanssen AD, Lewallen DG, Mabry TM. Morbid obesity: a significant risk factor for failure of two-stage revision total knee arthroplasty for infection. J Bone Joint Surg Am. 2014 Sep 17;96(18):e154. doi: 10.2106/JBJS.M.01289. PubMed PMID: 25232084.
Kuzyk PR, Dhotar HS, Sternheim A, Gross AE, Safir O, Backstein D. Two-stage revision arthroplasty for management of chronic periprosthetic hip and knee infection: techniques, controversies, and outcomes. J Am Acad Orthop Surg. 2014 Mar;22(3):153-64. doi: 10.5435/JAAOS-22-03-153. Review. PubMed PMID: 24603825.
- Following knee arthroplasty, a patient has a painful catching sensation with knee extension. A clunk is reproducible on examination. Which factor may increase the incidence of this complication?
- Varus alignment
- Smaller patella component size
- Polyethylene thickness
- Larger femoral component size
- Cruciate-retaining knee arthroplasty
- Smaller patella component size
RECOMMENDED READINGS
Costanzo JA, Aynardi MC, Peters JD, Kopolovich DM, Purtill JJ. Patellar clunk syndrome after total knee arthroplasty; risk factors and functional outcomes of arthroscopic treatment. J Arthroplasty. 2014 Sep;29(9 Suppl):201-4. doi: 10.1016/j.arth.2014.03.045. Epub 2014 May 24. PubMed PMID: 25034884.
Dennis DA, Kim RH, Johnson DR, Springer BD, Fehring TK, Sharma A. The John Insall Award: control-matched evaluation of painful patellar Crepitus after total knee arthroplasty. Clin Orthop Relat Res. 2011 Jan;469(1):10-7. doi: 10.1007/s11999-010-1485-3. PubMed PMID: 20706813; PubMed Central PMCID: PMC3008897.
Snir N, Schwarzkopf R, Diskin B, Takemoto R, Hamula M, Meere PA. Incidence of patellar clunk syndrome in fixed versus high-flex mobile bearing posterior-stabilized total knee arthroplasty. J Arthroplasty. 2014 Oct;29(10):2021-4. doi: 10.1016/j.arth.2014.05.011. Epub 2014 May 24. PubMed PMID: 24961894.
- What is the approximate normal ratio of the length of the patellar tendon to the height of the patella (distance from the superior to inferior poles)?
- 0.75:1
- 1:1
- 1.75:1
- 2:1
- 3:1
- 1:1
RECOMMENDED READINGS
Insall J, Salvati E. Patella position in the normal knee joint. Radiology. 1971 Oct;101(1):101-4. PubMed PMID: 5111961.
Shabshin N, Schweitzer ME, Morrison WB, Parker L. MRI criteria for patella alta and baja. Skeletal Radiol. 2004 Aug;33(8):445-50. Epub 2004 Jun 24. PubMed PMID: 15221214.
Aglietti P, Insall JN, Cerulli G. Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop Relat Res. 1983 Jun;(176):217-24. PubMed PMID: 6851329.
- Which medium of polyethylene sterilization by gamma radiation is associated with distinctively rapid in vivo wear?
- Argon
- Plasma
- Oxygen
- Nitrogen
- Ethylene oxide
- Oxygen
RECOMMENDED READINGS
Collier MB, Engh CA Jr, McAuley JP, Engh GA. Factors associated with the loss of thickness of polyethylene tibial bearings after knee arthroplasty. J Bone Joint Surg Am. 2007 Jun;89(6):1306-14. PubMed PMID: 17545435.
McGovern TF, Ammeen DJ, Collier JP, Currier BH, Engh GA. Rapid polyethylene failure of unicondylar tibial components sterilized with gamma irradiation in air and implanted after a long shelf life. J Bone Joint Surg Am. 2002 Jun;84-A(6):901-6. PubMed PMID: 12063322.
- What is the function of the structure visualized during the knee arthroscopy seen in Video 154?
- Lateral stability in flexion
- Lateral stability in extension
- Medial stability in flexion
- Medial stability in extension
- Posterior stability
- Lateral stability in flexion
RECOMMENDED READINGS
LaPrade MD, Kennedy MI, Wijdicks CA, LaPrade RF. Anatomy and biomechanics of the medial side of the knee and their surgical implications. Sports Med Arthrosc. 2015 Jun;23(2):63-70. doi: 10.1097/ JSA.0000000000000054. PubMed PMID: 25932874.
James EW, LaPrade CM, LaPrade RF. Anatomy and biomechanics of the lateral side of the knee and surgical implications. Sports Med Arthrosc. 2015 Mar;23(1):2-9. doi: 10.1097/JSA.0000000000000040. Review. PubMed PMID: 25545644.
- Polyethylene irradiation during the sterilization process produces
- longer shelf life.
- a smoother surface.
- decreased free radicals.
- decreased cross-linking.
- improved wear performance.
- improved wear performance.
RECOMMENDED READINGS
Crowninshield RD, Muratoglu OK; Implant Wear Symposium 2007 Engineering Work Group. How have new sterilization techniques and new forms of polyethylene influenced wear in total joint replacement? J Am Acad Orthop Surg. 2008;16 Suppl 1:S80-5. PubMed PMID 18612021.
Faris PM, Ritter MA, Pierce AL, Davis KE, Faris GW. Polyethylene sterilization and production affects wear in total hip arthroplasties. Clin Orthop Relat Res. 2006 Dec;453:305-8. PubMed PMID: 16906113.
- Figures 177a and 177b are the radiographs of a patient who underwent a total knee arthroplasty (TKA) 1 year ago and now has persistent pain. What is the most appropriate next step?
- Bone scan
- Observation
- CT scan
- Revision knee arthroplasty
- Complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)
- Complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)
RECOMMENDED READINGS
Parvizi J, Ghanem E, Sharkey P, Aggarwal A, Burnett RS, Barrack RL. Diagnosis of infected total knee: findings of a multicenter database. Clin Orthop Relat Res. 2008 Nov;466(11):2628-33. doi: 10.1007/s11999-008-0471-5. Epub 2008 Sep 10. PubMed PMID: 18781372; PubMed Central PMCID: PMC2565043.
Rosenthall L, Lepanto L, Raymond F. Radiophosphate uptake in asymptomatic knee arthroplasty. J Nucl Med. 1987 Oct;28(10):1546-9. PubMed PMID: 3655908.