Picture of a TKA at 8 weeks, well-aligned, no signs of failure, but ROM 5-80°. Plan?
D)
What is a disadvantage of ceramic bearings?
D)
Other disadvantage are:
Risk of fracture
Squeaking
Loss modularity
Stripe wear
5 things increase risk of squeaking
Edge loading
Impingement
Third body wear
Loss of fluid film lubrication
Thin flexible titanium stems
Where can you NOT use titanium?
A)
Shown a picture of a TKA with a periprosthetic femur fracture treated with a lateral plate. Presents with another fracture, for which you are considering a retrograde nail. Why would you like to have the previous OR reports?
B)
88- Patient 2 years post THA. Did well initially but now 2 weeks of pain shortly after dental work. Xray = well fixed (not shown). WBC 14, CRP 198. Tap = purulent material. Best option?
B)
Liner exchange if (True if with 48-72 hours of symptoms onset)
What is the theoretical goal of a trochanteric advancement surgery?
C)
Which is the best test to assess marotation of the components after a TKA?
A)
What is the most common cause of revision THA?
B)
Patient with groin pain worse with resisted flexion and adduction and they show you a lateral of a THA with increased cup retroversion. What is your plan?
D)
What is the problem with modular necks in THA?
A)
Metal ions cobalt 5x titanium
All are true regarding returning to driving after orthopedic surgery EXCEPT
B)
Braking function return
-4 weeks after knee scope
6 weeks after R ACL
2 weeks after L ACL
9 weeks after ankle ORIF
6 weeks after beginning of Weight bearing following fracture
Regarding the mechanical axis in the tibia, all are true except?
B)
they are not colinear
c is wrong to as per me
What is true about arthrofibrosis and lack of extension? Regarding post-op stiffness after TKA, which is true? (repeat)
D)
also cyclops lesion
fat pad (hoffa syndrome): diagnosed arthroscopically when there is hypertrophic intercondylar/or infrapatellar synovitis extending to central to the inner rim of the anterior horn of the meniscus
What is the least likely to result in decreased flexion?
B)
all others cause decrease flexion
Which of these anticoagulation therapies postop TJA has the lowest evidence supporting its use?
B)
What is the main difference between HCLPE and UHMWPE (UHMWPE vs XLPE)?
A)
HCLPE: is new generation
UHMWPE: older
Some question about something with poly (What determines scratch resistance?)
B)
The hardness of a material: defines its relative resistance that its surface opposes to the penetration of a harder body
Surface tension is: the elastic tendency of liquids which makes them acquire the least surface area possible
Surface roughness: is a component of surface texture. It is quantified by the deviations in the direction of the normal vector of a real surface from its ideal form
What is true about not performing patellar resurfacing?
C)
Can have more anterior knee pain
If already maltracking can be an indications for resurfacing
Which one is true of the direct lateral (Hardinge) approach for a THA? REPEAT
A)
When pre-op planning for a THA, the femoral mechanical axis is?
A)
What is the best indication for using a constrained liner in a revision total hip arthroplasty?
D)
If malpositioned > need to fix this first
C is wrong because you can treat the non union instead of using constrained liner
Regarding a TKA using a PCL-substituting prosthesis, which of the following is true?
C)
For post-traumatic or post-operative arthrofibrosis of the knee, which is true?
B)
hoffa sign(for infrapatellar scarring) : This test is performed with the knee in 30° of flexion; the thumbs are placed at the medial and lateral margins of the infrapatellar fat pad and patellar tendon. Pressure is applied with the thumb, and the knee is fully extended. Increased pain in the fat pad with knee extension indicates a positive result.
What can be done to increase the primary arc of motion in a total hip arthroplasty?
A)
In a patient with acetabular dysplasia, which position will provoke anterior instability?
D)
In order to determine the acetabular safe zone for screw placement, a line is drawn from where to where?
D)
Postero superior: safe zone
ANtero superior: can lacerate iliac vessels
All have been shown to decrease infection in TKA EXCEPT?
A)
Question about THA? All the following help with stability except
C)
Which of the following nerves is most commonly injured during THA?
A)
Which of the following has been shown to have the greatest increase in metal ions in pt with MOM THA?
A)
Abduction angle >55 leads to increased ion levels: edge loading
Regarding total elbow arthroplasty versus ORIF in comminuted distal humerus in elderly, which of the following is true?
C)
Which of the following structures is at risk when placing anterosuperior quadrant screws in an acetabular component (THA)?
Lady comes in 15 years post THA, pain for 2 years, activity related. All was well before that. ESR CRP normal. What is the next investigation?
C)
Which of the following THA components have the least wear?
A)
increased metal ions with smaller component size
Most risk to SGN in hip surgery?
B)
When doing a TKA for a varus knee and placing components perpendicular to mechanical axis, why do you externally rotate the femoral component?
D)
Simultaneous bilateral TKA are associated with more complications than single or staged bilateral TKA. Of those complications which of the following is associated with the highest odds ratio (simultaneous bilateral to unilateral)?
D)
3 increased are death cardiac event and pulmonary complications
Which of the following types of wear is most prevalent in Metal on Poly in THA?
D)
Type 1: btw 2 surfaces as intended( abrasive, adhesive)
TYPE 2: btw bearing surface and non bearing surface ( head and acetabulum)
Type 3: third body wear
Type 4: wear btw non bearing surfaces: backside wear (poly on cup from bad locking mechanism
All of the following are true regarding PMMA EXCEPT:
C)
AVN for hip. What’s the best predictable outcome?
C)
All of the following are true with PMMA EXCEPT:
C)
Which THA bearing surface has the lowest wear?
D)
What is most predicted of post op ROM post TKA
A)
70 M 2 years post THA. Presents with a fall and an obvious displaced fracture of the greater trochanter. What is the Vancouver classification of this, and the treatment?
A)
surgery if
pain
limp
instability
displacement >2.5 cm
What are good tests for figuring out if a metal prosthesis is infected?
B)
Which of the following is associated with decreased polyethelene wear in TKA?
C)
ethyline oxide gas: no cross linming and high wear rate
Which is not a way to improve the wear rates in polyethylene?
C)
Bilateral TKA simultaneous vs. staged which is true (Dalhousie asks “biggest odds ratio”)?
C)
During TKA, you use an extramedullary guide for the tibial component positioning. If you do not consider the rotation mismatch between the distal tibia and the proximal tibia, what is the expected problem in the implant position?
B)
What is true of ceramic bearings in THA
B)
Which is not true about ceramic on ceramic total hips?
B)
55 y.o. women one year post Metal on metal THA and states that her hip “never felt right” after surgery. No fevers or constitutional symptoms. Otherwise well and states that her x-rays are normal. All the following test are appropriate to order in the initial work up EXCEPT:
A)
Dude had TKA for years, then had toe infection 1 week ago, now knee is infected with positive tap for gram + cocci in clusters, management?
A)
Since i is acute (<3 weeks)
Sciatic nerve in THA. All of the following are true except:
D)
only 30-40% recover after full palsy
5 risk factors for sciatic nerve palsy in THA
DDH
Revision
Female
Limb lenghtening
Post traumatic OA
TKA patellar question, all true EXCEPT?
B)
lack of appropiate Er leads to maltracking
With regards to patellar resurfacing. All of the following except:
B)
Position of hip fusion
A)
Which one of these is an indication for a UKA?
C)
Indications of UKA
Unicompartmental OA
Age >60 with low demand
Not obese
ROm >90 degrees with <5 FFC
Angular deformity <15 degrees that is passively correctible
Elderly female post THA with RA that got 1 unit post op, 2 L N/S post op, u/o 150 cc on last 2 hours, Hb is 95, resting, comfortable, no pain, HR 89, BP 85/60, called to assess, what to do?
A)
While systematically balancing a valgus TKA, what will you do to address lateral tightness in extension?
B)
Mobile bearing, what is true? What is the advantage of mobile vs. fixed bearings in TKA?
A)
XR of a hip w/ vascularized fibula. Question asked - The underlying pathology that this treatment was used for could be caused by all of the following except:
D)
What is the most common neuroma following TKA:
D)
Infrapatellar branch of saphenous N
What is the least common complication after THA:
D)
Which of these regarding patella and TKA is incorrect?
A)
Changes in higher cross-linked polyethylene leads to
D)
High cross linked: decrease fatigue/tensile strenght/fracture toughness
2 advantages of crosslinked poly
Improved wear rates
Improved resistance to adhesive and abrasive wear
5 disadvantages of highly crosslinked poly
Decreased tensile strenght
Decreased fatigue strenght
Decrease fracture toughness: force required to propagate a crack
Decreased ductiliy: more brittle
Higher fracture rate with edge loading
What sign on a pelvic radiograph helps to diagnosis femoral acetabular impingement
C)
Why is cross-linked poly heated after irradiation?
A)
called annealing and its done after irradiation
A patient with a unicondylar knee Hemiarthroplasty fails due to aseptic loosening. With regard to his revision surgery
D)
A patient with a BMI of 38 (260lbs) presents with PF pain and mild OA. Radiographs show a small patella osteophyte and spiking of the spines. She is minimally disabled with regards to her ADL’s. Management should be
B)
Fusion of bilateral elbows, what position
A)
110: mouth reach
65: personal hygene
90 degrees if unilateral
30 yo drunk with Ficat III on one side, Ficat I on the other, what to do with FICAT III
C)
<45 with fict 3: osteotomy need kerboul angle <200
<45 ficat IV: THA
What can prevent collapse in idiopathic AVN of the femoral head?
C)
alendronate worked for steinberg II or IIIC non traumatic
Fusion of bilateral elbows, what position
A)
Charnley cemented THA in 40 – 45 year olds – survivorship at 10 years?
A)
Incidence of subclinical sciatic nerve injury during THA surgery
C)
What is the benefit of ceramic on ceramic THA
D)
105-What is the most significant factor for wear in THA
C)
Age and activity levels
AVN rate with posterior dislocation of hip
D)
Risk of DVT with use of tourniquet
None
You do a THA and put the acetabulum with 45 degree lateral tilt, neutral version. You put the stem in neutral version. What is this patient at risk for?
A)
What is the most common mode of wear contributing to THA osteolysis
D)
Cemented THA with grit-blasted vs smooth stems. What is the disadvantage of using grit-blasted stems
C)
Doing a THA for DDH, you expect all except one
floor
d) Deficient medial acetabular dome
B)
What is the benefit of ceramic on ceramic THA
B)
Best position for hip fusion
A)
Flexion contracture in hip – 20-115 degree arc of motion. 42 year old pt with OA. Which of the following is true
D)
THA in Hemophilia, all are true except:
A)
THA in sickle cell, all are true except:
A)
Tantalum better as an acetabular shell, all are true, except?
A)
1st Generation Metal on Metal arthroplasty was abandoned for all these reasons, EXCEPT?
B)
DYoung guy with groin pain. Non drinker, no meds, no PMHx. You are told that X-rays are completely normal. You are given a coronal MRI which shows blacked-out femoral head with no collapse. What is your best treatment?.
D)
Increased Risk of HO after total hip arthroplasty…everyone EXCEPT?
