Arthroplasty — MCQs
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Which of the following is considered a fenestrated hip prosthesis?
A patient with an orthopaedic hip implant is to undergo dental extraction. What antibiotic prophylaxis is recommended?
Who is considered the father of joint replacement surgery?
During hip replacement surgery, loss of joint and ligament receptors leads to which of the following outcomes regarding sensation and proprioception?
Which of the following are major indications for arthroplasty?
Who is considered the father of joint replacement surgery?
Patellar clunk is a known complication of which surgery?
A Baker's cyst is a type of:
Aseptic loosening in cemented total hip replacement occurs as a result of hypersensitivity response to which of the following?
What is the best treatment for a fracture neck of femur in a 65-year-old lady?
Arthroplasty Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is considered a fenestrated hip prosthesis?
- A. Bipolar prosthesis
- B. Austin Moore prosthesis (Correct Answer)
- C. Thompson prosthesis
- D. All of the above
Explanation: **Explanation:** The correct answer is **Austin Moore prosthesis**. In orthopaedic surgery, a **fenestrated prosthesis** refers to an implant with "windows" or openings in its stem. These holes allow for bone to grow through the prosthesis (biological fixation), providing long-term stability. **1. Why Austin Moore is correct:** The Austin Moore prosthesis is a unipolar hemiarthroplasty implant used for femoral neck fractures. Its defining feature is a **fenestrated stem**. During surgery, bone chips are often packed into these fenestrations; over time, bone grows through these holes (osseointegration), anchoring the prosthesis to the femoral shaft without the need for bone cement. **2. Why the other options are incorrect:** * **Thompson prosthesis:** This is also a unipolar prosthesis, but it has a **solid (non-fenestrated) stem**. It is designed to be used with bone cement (Polymethylmethacrylate - PMMA) for fixation. * **Bipolar prosthesis:** This refers to an implant with two points of articulation (one at the acetabulum and one within the prosthetic head). While the stem design can vary, the term "bipolar" describes the head mechanism, not the presence of fenestrations. **High-Yield Clinical Pearls for NEET-PG:** * **Fixation:** Austin Moore = **Uncemented** (Press-fit/Biological); Thompson = **Cemented**. * **Indications:** Austin Moore is preferred in patients with good bone quality; Thompson is preferred in osteoporotic patients where cement provides immediate stability. * **Calcar:** The Austin Moore prosthesis has a collar that rests on the calcar femorale to prevent subsidence. * **Complication:** A common complication of unipolar prostheses (Moore/Thompson) is **acetabular erosion** (protrusio acetabuli) because the metal head rubs directly against the native cartilage.
Question 2: A patient with an orthopaedic hip implant is to undergo dental extraction. What antibiotic prophylaxis is recommended?
- A. Amoxicillin 3 times a day for 3 days before the procedure
- B. Amoxicillin 3 times a day for 1 day before the procedure
- C. Amoxicillin intravenously 1 hour before the procedure
- D. Antibiotic prophylaxis is not required (Correct Answer)
Explanation: **Explanation:** The correct answer is **D. Antibiotic prophylaxis is not required.** **1. Underlying Medical Concept:** Historically, it was believed that dental procedures could cause transient bacteremia leading to Late Prosthetic Joint Infection (PJI). However, current evidence-based guidelines from the **American Academy of Orthopaedic Surgeons (AAOS)** and the **American Dental Association (ADA)** state that there is no direct link between dental procedures and PJI. Routine antibiotic prophylaxis is **not recommended** for patients with prosthetic joint replacements undergoing dental procedures. The risks of antibiotic use (allergic reactions, *C. difficile* infection, and antimicrobial resistance) outweigh the unproven benefits of preventing joint infection. **2. Why Incorrect Options are Wrong:** * **Options A and B:** Prophylaxis is never administered for multiple days or a full day before a procedure. If prophylaxis were indicated (e.g., for infective endocarditis), it would be a single pre-operative dose. * **Option C:** While IV antibiotics are used for surgical prophylaxis (like during the arthroplasty itself), they are not indicated for dental work in patients with joint implants. **3. Clinical Pearls for NEET-PG:** * **Exception:** Prophylaxis may be considered only in **severely immunocompromised** patients (e.g., stage 3 AIDS, chemotherapy, or recent organ transplant) with poorly controlled oral infections, and even then, only after consultation between the dentist and the orthopedic surgeon. * **Timing:** If prophylaxis is deemed necessary for other reasons (like high-risk cardiac conditions), the standard dose is **2g Amoxicillin orally 30-60 minutes before** the procedure. * **High-Yield Fact:** The most common cause of Late PJI is hematogenous spread, but the source is usually skin or urinary tract infections, not dental flora.
Question 3: Who is considered the father of joint replacement surgery?
- A. Manning
- B. Gridlestone
- C. Charnley (Correct Answer)
- D. Ponseti
Explanation: **Explanation:** **Sir John Charnley** is universally recognized as the **"Father of Modern Joint Replacement"** for his pioneering work in Total Hip Arthroplasty (THA). In the early 1960s, he revolutionized the field by introducing the **Low Friction Arthroplasty (LFA)**. His three landmark contributions include: 1. The use of **Ultra-High-Molecular-Weight Polyethylene (UHMWPE)** for the socket. 2. The use of **Polymethylmethacrylate (PMMA)** bone cement for stable fixation. 3. The concept of a **small diameter femoral head (22.25 mm)** to reduce torque and wear. **Analysis of Incorrect Options:** * **Manning:** Not associated with the development of joint replacement; likely a distractor in the context of orthopedic history. * **Girdlestone:** Known for the **Girdlestone excision arthroplasty**, which involves removing the femoral head and neck without replacement. It is now primarily used as a salvage procedure for infected hip replacements. * **Ponseti:** Famous for the **Ponseti technique**, the gold standard non-operative treatment for Congenital Talipes Equinovarus (CTEV/Clubfoot) using serial casting. **High-Yield Clinical Pearls for NEET-PG:** * **Charnley’s Triad:** Low friction principle, Bone cement (PMMA), and UHMWPE. * **PMMA:** Acts as a grout (filler), not a glue. A common complication during its insertion is **Bone Cement Implantation Syndrome (BCIS)**, characterized by hypoxia and hypotension. * **Clean Air Rooms:** Charnley also pioneered the use of laminar airflow in operating theaters to reduce surgical site infections.
Question 4: During hip replacement surgery, loss of joint and ligament receptors leads to which of the following outcomes regarding sensation and proprioception?
- A. No significant loss of joint sensation or proprioception. (Correct Answer)
- B. Complete loss of all joint sensations and proprioception.
- C. Joint sensation is lost only in unstable positions.
- D. A decrease in proprioception and a decrease in motor control.
Explanation: ### Explanation **1. Why Option A is Correct:** Total Hip Arthroplasty (THA) involves the removal of the femoral head and acetabular cartilage, which contain mechanoreceptors (Ruffini endings, Pacinian corpuscles, and Golgi-like organs). While these intra-articular receptors are lost, **proprioception and joint sensation are largely preserved** because the majority of proprioceptive feedback for the hip joint is derived from the **surrounding musculature (muscle spindles), tendons (Golgi tendon organs), and the remaining joint capsule.** Studies have shown that after the initial postoperative recovery, patients often demonstrate proprioceptive accuracy similar to or even better than their pre-operative state, likely due to the relief of pain and restoration of mechanical stability. **2. Why the Other Options are Incorrect:** * **Option B:** This is a common misconception. Proprioception is a multi-modal system; losing one component (intra-articular receptors) does not lead to a "complete loss" because extra-articular structures remain intact. * **Option C:** Joint sensation is not position-dependent in this manner. While mechanoreceptors fire more at terminal ranges of motion, the overall sensation remains functional throughout the arc of movement due to muscular feedback. * **Option D:** In the long term, THA generally **improves** motor control by restoring the center of rotation and improving the lever arm of the abductor muscles (Gluteus Medius), rather than decreasing it. **3. Clinical Pearls for NEET-PG:** * **Mechanoreceptors:** The hip capsule contains four types of receptors. Type I (Ruffini) and Type II (Pacinian) are the most critical for signaling joint position. * **Pain vs. Proprioception:** Chronic osteoarthritis actually impairs proprioception due to pain-induced inhibition. Therefore, replacing the joint often results in a net **gain** in functional proprioception. * **High-Yield Fact:** The **Gluteus Medius** is the most important muscle for post-operative hip stability and gait (Trendelenburg sign); its nerve supply (Superior Gluteal Nerve) must be protected during the lateral approach.
Question 5: Which of the following are major indications for arthroplasty?
- A. Osteoarthritis of the hip (Correct Answer)
- B. Ankylosis of the elbow
- C. Ununited tibial fracture
- D. Ununited femoral neck fracture
Explanation: **Explanation:** Arthroplasty is a reconstructive surgical procedure aimed at restoring the function of a joint by resurfacing or replacing it. The primary goals are pain relief and restoration of mobility. **1. Why Option A is Correct:** **Osteoarthritis (OA) of the hip** is the most common major indication for total hip arthroplasty (THA). In advanced OA, the articular cartilage is destroyed, leading to "bone-on-bone" contact, debilitating pain, and loss of range of motion. Arthroplasty provides a definitive solution by replacing the damaged joint surfaces with prosthetic components, significantly improving the patient's quality of life. **2. Why the Other Options are Incorrect:** * **Ankylosis of the elbow (B):** While arthroplasty can be done for ankylosis, it is technically challenging and often considered a relative indication. In many cases of elbow ankylosis (especially post-traumatic), excision arthroplasty or functional bracing is preferred over prosthetic replacement due to high complication rates. * **Ununited tibial fracture (C):** Non-union of long bone diaphyses (like the tibia) is managed with stable internal fixation (e.g., intramedullary nailing or plating) and bone grafting, not joint replacement. * **Ununited femoral neck fracture (D):** While hemiarthroplasty or THA is a treatment for femoral neck fractures in the elderly, the *primary* indication for arthroplasty in trauma is the fracture itself (to avoid avascular necrosis), not necessarily the "un-union" stage, which might sometimes be managed with valgus osteotomy in younger patients. **High-Yield Clinical Pearls for NEET-PG:** * **Most common indication for THA:** Osteoarthritis. * **Most common indication for TKA (Knee):** Osteoarthritis. * **Absolute Contraindication:** Active systemic or local infection (sepsis/septic arthritis). * **Charnley’s Low Friction Arthroplasty:** The "Gold Standard" design for THA using a metal head and a polyethylene socket.
Question 6: Who is considered the father of joint replacement surgery?
- A. Manning
- B. Girdlestone
- C. Charnley (Correct Answer)
- D. Ponseti
Explanation: **Explanation:** **Sir John Charnley** is universally recognized as the "Father of Modern Joint Replacement Surgery." His pioneering work in the 1960s revolutionized the treatment of end-stage arthritis. He developed the **Low Friction Arthroplasty (LFA)**, which introduced three fundamental principles still used in modern hip replacements: 1. **Low Friction Principle:** Using a small diameter femoral head (22.22 mm) to reduce torque. 2. **Material Science:** The use of High-Density Polyethylene (HDPE) for the socket and stainless steel for the femoral component. 3. **Fixation:** The use of self-curing acrylic bone cement (Polymethylmethacrylate - PMMA) for stable fixation. **Analysis of Incorrect Options:** * **Manning:** Not a primary figure associated with the foundational development of arthroplasty. * **Girdlestone:** Known for the **Girdlestone Procedure** (Excision Arthroplasty), where the femoral head and neck are removed without replacement. It is now primarily used as a salvage procedure for infected hip replacements. * **Ponseti:** Known for the **Ponseti Technique**, which is the gold standard non-operative treatment for Clubfoot (Congenital Talipes Equinovarus - CTEV) using serial casting. **High-Yield Clinical Pearls for NEET-PG:** * **Charnley’s Triad:** Small head, Polyethylene socket, and Bone cement. * **Clean Air Rooms:** Charnley also pioneered the use of laminar airflow in operating theaters to reduce surgical site infections. * **The "Father of Orthopaedics":** Often refers to **Nicolas Andry** (who coined the term) or **Hugh Owen Thomas** (modern clinical orthopaedics). * **Austin Moore:** Known for the first metallic prosthesis for hemiarthroplasty (unipolar).
Question 7: Patellar clunk is a known complication of which surgery?
- A. Corrective osteotomy for genu valgum
- B. Total knee replacement (Correct Answer)
- C. Medial patellofemoral ligament reconstruction
- D. Bicondylar plating of proximal tibia fracture
Explanation: **Explanation:** **Patellar Clunk Syndrome** is a specific complication associated with **Total Knee Replacement (TKR)**, particularly in Posterior-Stabilized (PS) designs. It occurs due to the formation of a painful fibrous nodule at the superior pole of the patella (at the junction of the quadriceps tendon and the proximal patellar button). When the knee moves from flexion to extension (typically between 30° and 45°), this nodule gets caught in the intercondylar notch of the femoral component and then "pops" or "clunks" out as the knee straightens. **Analysis of Options:** * **Option A & D:** Corrective osteotomies and proximal tibia plating involve extra-articular or intra-articular bone realignment/fixation. While they may cause stiffness or patellofemoral pain, they do not involve the prosthetic intercondylar notch necessary to produce a "clunk." * **Option C:** MPFL reconstruction addresses patellar instability. While it can lead to over-tightening or restricted motion, it does not involve the specific fibrous-prosthetic impingement seen in TKR. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factor:** More common in **Posterior-Stabilized (PS)** knee designs because the "box" (intercondylar notch) provides a space for the nodule to entrap. * **Clinical Presentation:** A painful "catch" or audible "thud" during active knee extension. * **Management:** Initial treatment is conservative, but definitive treatment is **arthroscopic debridement** (resection of the fibrous nodule). * **Prevention:** Modern TKR designs have a more "anatomical" femoral trochlea and a superiorly placed box to reduce this impingement.
Question 8: A Baker's cyst is a type of:
- A. Pulsion diverticulum of the knee joint (Correct Answer)
- B. Retention cyst
- C. Bursitis
- D. Benign tumor
Explanation: **Explanation:** A **Baker’s cyst** (also known as a popliteal cyst) is not a true cyst but rather a **pulsion diverticulum** of the synovial membrane of the knee joint. 1. **Why Option A is Correct:** The cyst is formed by the herniation of the synovial membrane through the posterior capsule of the knee, typically between the medial head of the gastrocnemius and the semimembranosus tendons. It occurs due to increased intra-articular pressure (pulsion) caused by underlying joint pathology (e.g., osteoarthritis or meniscal tears). A one-way valve mechanism allows synovial fluid to enter the cyst but prevents it from returning to the joint. 2. **Why other options are incorrect:** * **Retention Cyst:** These occur due to the obstruction of a gland's duct (e.g., sebaceous cyst). Baker’s cysts are formed by pressure-driven herniation, not ductal blockage. * **Bursitis:** While a Baker’s cyst often involves the gastrocnemio-semimembranosus bursa, it is specifically a communication/herniation of the joint space rather than simple primary inflammation of a bursa. * **Benign Tumor:** It is a fluid-filled reactive sac, not a neoplastic growth of cells. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Most commonly found in the **posteromedial** aspect of the popliteal fossa. * **Associated Conditions:** In adults, it is usually secondary to **Osteoarthritis** (most common) or Rheumatoid Arthritis. In children, it is often primary and idiopathic. * **Foucher’s Sign:** The cyst becomes firm on knee extension and soft on flexion (helps differentiate it from a popliteal artery aneurysm). * **Complication:** Rupture of the cyst can mimic **Deep Vein Thrombosis (DVT)**, presenting with sudden calf pain and swelling (Pseudothrombophlebitis).
Question 9: Aseptic loosening in cemented total hip replacement occurs as a result of hypersensitivity response to which of the following?
- A. Titanium debris
- B. High density polythene debris (Correct Answer)
- C. N,N-Dimethyltryptamine (DMT)
- D. Free radicals
Explanation: ### Explanation **Aseptic loosening** is the most common cause of long-term failure in cemented Total Hip Replacement (THR). The underlying mechanism is a biological response known as **"Particle Disease"** or **Osteolysis**. **1. Why High-density polythene (HDPE) debris is correct:** The primary culprit is the wear and tear of the polyethylene liner. As the metal/ceramic head rubs against the polyethylene socket, microscopic debris (wear particles) is released. These particles are phagocytosed by **macrophages**, which are unable to digest them. This triggers a chronic inflammatory response, leading to the release of pro-inflammatory cytokines (IL-1, IL-6, TNF-α) and RANK-L. This cascade activates **osteoclasts**, causing periprosthetic bone resorption (osteolysis), which eventually leads to the loosening of the implant. **2. Analysis of Incorrect Options:** * **Titanium debris:** While metal debris can cause "metallosis," titanium is highly biocompatible. Polyethylene wear is significantly more common and potent in inducing the osteolytic cascade in standard THR. * **N,N-Dimethyltryptamine (DMT):** This is a hallucinogenic tryptamine drug and has no clinical relevance to orthopedic implants or aseptic loosening. * **Free radicals:** While oxidative stress occurs during inflammation, free radicals are secondary byproducts and not the primary inciting "hypersensitivity" or particulate trigger for aseptic loosening. **Clinical Pearls for NEET-PG:** * **Most common cause of THR failure:** Aseptic loosening (late) vs. Infection (early). * **Interface:** In cemented THR, loosening typically occurs at the **cement-bone interface**. * **Radiographic sign:** A lucent line >2mm at the interface or "progressive" lucency (Gruen zones for femur, DeLee and Charnley zones for acetabulum). * **Prevention:** The use of **Highly Cross-Linked Polyethylene (HXLPE)** has significantly reduced wear rates and the incidence of aseptic loosening in modern arthroplasty.
Question 10: What is the best treatment for a fracture neck of femur in a 65-year-old lady?
- A. Pop cast
- B. Gleohy - I suspect this is a typo and should be 'Galeal tendon' which doesn't fit here, or potentially a less common fracture treatment term. I will assume it's a typo and leave it as is for now, but it is highly suspect.
- C. Bone grafting and compression
- D. Hemireplacement arthroplasty (Correct Answer)
Explanation: **Explanation:** The management of a fracture of the neck of the femur is primarily determined by the **age of the patient** and the **displacement of the fracture**. In an elderly patient (typically >60–65 years), the blood supply to the femoral head (via the retinacular vessels) is highly precarious. Displaced fractures carry a high risk of **Avascular Necrosis (AVN)** and non-union. **Why Hemireplacement Arthroplasty is correct:** For a 65-year-old patient, the goal is early mobilization to prevent complications of prolonged bed rest (like DVT or pneumonia). Hemireplacement arthroplasty (e.g., Austin Moore or Bipolar prosthesis) allows for immediate weight-bearing and avoids the high failure rate associated with internal fixation in osteoporotic elderly bone. **Analysis of Incorrect Options:** * **A. Pop cast:** Hip fractures are "unstable" and cannot be managed by immobilization in a cast. This leads to malunion and fatal complications of recumbency. * **B. Gleohy:** This appears to be a typographical error (likely intended to be Girdlestone excision arthroplasty or a similar term). Regardless, excision arthroplasty is a salvage procedure, not a primary treatment. * **C. Bone grafting and compression:** This is generally reserved for younger patients (<55 years) where "head-salvage" is the priority. In a 65-year-old, the risk of AVN outweighs the benefits of attempting to save the natural femoral head. **NEET-PG High-Yield Pearls:** * **Young patients (<55 yrs):** Emergency ORIF (Internal fixation) with Cannulated Cancellous Screws. * **Elderly (>65 yrs) & Sedentary:** Hemireplacement Arthroplasty. * **Elderly (>65 yrs) & Active:** Total Hip Arthroplasty (THA) is preferred over Hemireplacement to provide better long-term functional outcomes. * **Garden Classification:** Used to grade displacement; Stages III and IV have the highest risk of AVN.
Question 11: Aseptic loosening in cemented total hip replacement occurs as a result of a hypersensitivity response to which of the following?
- A. Titanium debris
- B. High-density polyethylene debris (Correct Answer)
- C. N,N-Dimethyltryptamine (DMT)
- D. Free radicals
Explanation: **Explanation:** **Aseptic loosening** is the most common cause of long-term failure in total hip replacement (THR). The primary pathophysiology involves a biological response to wear debris, known as **"Particle Disease."** 1. **Why High-density polyethylene (HDPE) is correct:** The repetitive motion of the metal femoral head against the polyethylene liner produces microscopic wear particles. These particles (specifically those sized 0.1–10 μm) are phagocytosed by **macrophages**. This triggers an inflammatory cascade involving the release of cytokines (IL-1, IL-6, TNF-α) and RANKL. This process leads to **osteoclast activation**, resulting in periprosthetic bone resorption (osteolysis) and subsequent loosening of the implant. 2. **Analysis of Incorrect Options:** * **Titanium debris:** While metal debris can cause "metallosis," polyethylene wear is the dominant cause of osteolysis in conventional cemented THR. * **N,N-Dimethyltryptamine (DMT):** This is a hallucinogenic drug and has no clinical relevance to orthopaedic implants or aseptic loosening. (Note: The chemical used in bone cement is Methylmethacrylate; DMT is likely a distractor for N,N-dimethyl-p-toluidine, an accelerator in cement). * **Free radicals:** While oxidative stress occurs during inflammation, they are secondary products and not the primary inciting agent for the hypersensitivity/osteolytic response. **Clinical Pearls for NEET-PG:** * **Interface:** In cemented THR, loosening most commonly occurs at the **cement-bone interface**. * **Gold Standard:** The most effective way to reduce polyethylene wear is the use of **Highly Cross-Linked Polyethylene (HXLPE)**. * **Radiographic Sign:** Look for "linear osteolysis" or "lucent lines" >2mm wide around the prosthesis (Gruen zones for femur, DeLee and Charnley zones for acetabulum).
Question 12: The Watson-Jones approach is indicated for which of the following conditions?
- A. Neglected club foot
- B. Muscle paralysis
- C. Valgus deformity
- D. Hip replacement (Correct Answer)
Explanation: The **Watson-Jones approach** is a classic **anterolateral approach** to the hip joint. It utilizes the internervous plane between the **Tensor Fasciae Latae (TFL)**, supplied by the Superior Gluteal Nerve, and the **Gluteus Medius**, also supplied by the Superior Gluteal Nerve (though they are technically in the same nerve group, the plane is functional and anatomical). ### Why Hip Replacement is Correct This approach provides excellent exposure of the acetabulum and the femoral neck. It is frequently used for **Total Hip Arthroplasty (THA)**, hemiarthroplasty, and internal fixation of femoral neck fractures. Its primary advantage is a lower rate of posterior dislocation compared to the posterior (Moore’s) approach, as the posterior capsule remains intact. ### Why Other Options are Incorrect * **Neglected Club Foot:** This requires soft tissue releases (like the Turco’s procedure) or bony procedures (like Triple Arthrodesis or Ilizarov) involving the foot and ankle, not the hip. * **Muscle Paralysis:** While surgical releases or tendon transfers are used in paralytic conditions (e.g., Polio or CP), the Watson-Jones is a specific surgical *access* route for the joint, not a corrective procedure for paralysis itself. * **Valgus Deformity:** Genu valgum (at the knee) is typically corrected via medial closing wedge or lateral opening wedge osteotomies around the knee, not through a hip approach. ### High-Yield Clinical Pearls for NEET-PG * **Internervous Plane:** Watson-Jones is often described as "intermuscular" but not strictly "internervous" in some texts because both muscles are supplied by the **Superior Gluteal Nerve**. * **Patient Position:** Usually performed in the lateral or supine position. * **Comparison:** Unlike the **Smith-Petersen (Anterior) approach**, which uses the plane between Sartorius (Femoral n.) and TFL (SGN), the Watson-Jones is more lateral. * **Complication:** The most common nerve at risk during this approach is the **Superior Gluteal Nerve**, which can lead to a Trendelenburg gait if damaged.
Question 13: Metal on metal articulation in arthroplasty should be avoided in which of the following scenarios?
- A. Osteonecrosis
- B. Young female (Correct Answer)
- C. Inflammatory arthritis
- D. Revision surgery
Explanation: **Explanation:** The correct answer is **Young female**. The primary concern with Metal-on-Metal (MoM) bearings is the generation of metallic debris (cobalt and chromium ions) due to wear. These ions enter the systemic circulation and can cross the placental barrier. 1. **Why Young Females?** In women of childbearing age, there is a significant risk of **teratogenicity**. Elevated serum levels of cobalt and chromium can potentially harm the developing fetus. Furthermore, MoM articulations are associated with **ALVAL** (Aseptic Lymphocytic Vasculitis-Associated Lesions) and **pseudotumors**, which may lead to early implant failure in active individuals. 2. **Why other options are incorrect:** * **Osteonecrosis & Inflammatory Arthritis:** These are standard indications for total hip arthroplasty. While the choice of bearing surface depends on age and activity level, MoM is not specifically contraindicated based on the underlying pathology alone, unlike the systemic risk in pregnancy. * **Revision Surgery:** While revision surgery is complex, the choice of bearing depends on bone stock and previous implant failure reasons. MoM is not a primary contraindication here, though it is currently less favored than Ceramic-on-Polyethylene. **High-Yield Clinical Pearls for NEET-PG:** * **Adverse Reaction to Metal Debris (ARMD):** Includes pseudotumors, tissue necrosis, and osteolysis. * **Hypersensitivity:** MoM can trigger a Type IV delayed hypersensitivity reaction. * **Current Trend:** Due to high failure rates and "metallosis," MoM has largely been replaced by **Ceramic-on-highly cross-linked Polyethylene (HXLPE)**, which is currently considered the gold standard for young, active patients. * **Safe levels:** Serum Cobalt levels **>7 ppb (parts per billion)** are often indicative of significant wear or impending MoM implant failure.
Question 14: 79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?
- A. Hip spica
- B. Nailing
- C. Hemiahroplasty (Correct Answer)
- D. Total Hip Replacement
Explanation: ***Hemiarthroplasty*** - The X-ray shows a **displaced femoral neck fracture** in an elderly patient, which typically has a high risk of **avascular necrosis** of the femoral head due to disruption of blood supply. - Hemiarthroplasty involves replacing only the **femoral head and neck** with a prosthetic component, leaving the acetabulum intact, which is suitable for elderly patients with good acetabular cartilage and less active lifestyles. *Hip spica* - A hip spica cast is primarily used for **pediatric femur fractures** or certain types of hip dislocations in children, not for displaced femoral neck fractures in elderly adults. - This method would not provide stable fixation or address the high risk of **avascular necrosis** associated with these fractures in older patients. *Nailing* - Nailing (intramedullary nailing) is typically used for **intertrochanteric fractures** or subtrochanteric fractures, where the fracture line is distal to the femoral neck. - For displaced femoral neck fractures, nailing alone may not provide adequate stability and carries a higher risk of **non-union** or **avascular necrosis** compared to arthroplasty in elderly patients. *Total Hip Replacement* - Total hip replacement involves replacing both the **femoral head and the acetabulum** with prosthetic components. - While an option for femoral neck fractures, it is generally reserved for younger, more active patients or those with pre-existing **acetabular pathology** like arthritis, as it is a more extensive and complex procedure than hemiarthroplasty.
Question 15: The most common approach for total hip arthroplasty is
- A. Anteromedial
- B. Posteromedial
- C. Anterolateral
- D. Posterolateral (Correct Answer)
Explanation: ***Posterolateral*** - The **posterolateral approach** is the most widely adopted and versatile surgical technique for **total hip arthroplasty (THA)**. - It offers excellent exposure of the hip joint, allowing for efficient component placement and often results in **lower blood loss** compared to other approaches. *Anteromedial* - The **anteromedial approach** is rarely used for THA due to poor exposure of the acetabulum and femoral canal. - It carries a higher risk of injury to crucial neurovascular structures, such as the **femoral artery** and **vein**. *Posteromedial* - The **posteromedial approach** is not a standard or commonly recognized surgical approach for total hip arthroplasty. - Surgical approaches are typically classified as anterior, anterolateral, direct lateral, or posterolateral. *Anterolateral* - The **anterolateral approach** involves splitting the **tensor fascia lata** and detaching the **gluteus medius** from the greater trochanter. - While it has a lower risk of posterior dislocation, it can be associated with a higher incidence of **abductor muscle weakness** and limping post-operatively.
Question 16: All of the following factors affect osseointegration EXCEPT:
- A. Biocompatibility of implant material.
- B. Implant design.
- C. Patient's blood type (Correct Answer)
- D. Status of the host bed.
Explanation: ***Patient's blood type*** - A patient's **blood type** (e.g., A, B, AB, O) is determined by antigens present on red blood cells and plays no direct role in the biological processes of bone healing or the integration of a dental implant with bone. - While systemic factors can influence osseointegration, blood type itself does not affect the cellular and molecular mechanisms required for direct bone-to-implant contact. *Biocompatibility of implant material* - The **biocompatibility** of the implant material (e.g., **titanium**) is crucial for osseointegration, as it must not elicit adverse reactions and must permit host bone growth on its surface. - Materials that are cytotoxic or inflammatory will prevent bone apposition and lead to fibrous encapsulation rather than direct bone contact. *Implant design* - **Implant design**, including features like **surface roughness**, thread pitch, and macro-geometry, significantly influences the initial stability and long-term success of osseointegration. - A greater surface area and appropriate surface treatments can enhance bone cell attachment and differentiation, promoting faster and stronger bone integration. *Status of the host bed* - The **status of the host bone bed** refers to its quality and quantity (e.g., bone density, vascularity), which are critical for the biological processes of osseointegration. - Adequate bone volume and good bone quality provide a stable foundation and sufficient blood supply for bone regeneration around the implant.
Question 17: Severe disability in primary osteoarthritis of hip is best managed by -
- A. Arthroplasty (Correct Answer)
- B. Arthrodesis
- C. Mc Murray's osteotomy
- D. Intra-articular hydrocortisone and physiotherapy
Explanation: ***Arthroplasty*** - **Total hip arthroplasty (THA)** is the most effective treatment for severe osteoarthritis of the hip, providing significant pain relief and functional improvement. - It involves replacing the damaged joint surfaces with **prosthetic components**, addressing advanced cartilage loss and structural damage. *Arthrodesis* - **Arthrodesis (joint fusion)** is an older technique that fixes the joint in a permanent position, eliminating pain but sacrificing all motion in that joint. - While it relieves pain, the severe loss of motion makes it generally less desirable than arthroplasty for the hip, especially in active patients. *Mc Murray's osteotomy* - **McMurray's osteotomy** is a surgical procedure primarily used for some types of **femoral neck fractures** or a specific type of **avascular necrosis** of the femoral head, not for severe osteoarthritis affecting the entire joint. - It involves cutting and realigning the bone, but it does not address advanced, widespread articular cartilage degeneration seen in severe osteoarthritis. *Intra-articular hydrocortisone and physiotherapy* - **Intra-articular hydrocortisone injections** and **physiotherapy** are conservative treatments used for mild to moderate hip osteoarthritis to manage pain and improve function. - These methods do not resolve severe structural damage and are typically insufficient for managing severe disability due to advanced osteoarthritis.
Question 18: Watson Jones Operation is the procedure for which of the following conditions?
- A. Neglected Clubfoot
- B. Valgus deformity
- C. Recurrent shoulder dislocation (Correct Answer)
- D. Muscle paralysis
Explanation: ***Recurrent shoulder dislocation*** - The **Watson-Jones procedure** is a surgical technique primarily used to address **recurrent anterior shoulder dislocations**. - It involves transferring the **conjoint tendon** (coracobrachialis and short head of biceps) to reconstruct the anterior capsule and provide stability. *Neglected Clubfoot* - **Clubfoot**, or talipes equinovarus, is typically managed by the **Ponseti method** (serial casting) for congenital cases. - Surgical correction for neglected clubfoot usually involves extensive soft tissue releases or osteotomies, not the Watson-Jones procedure. *Valgus deformity* - A **valgus deformity** refers to an angulation away from the midline, commonly seen in the knee (genu valgum) or ankle. - Correction typically involves osteotomies or soft tissue balancing, not the Watson-Jones procedure. *Muscle paralysis* - **Muscle paralysis** is managed based on its cause, which can include nerve repair, tendon transfers (e.g., for wrist or foot drop), or assistive devices. - The Watson-Jones procedure is designed for joint stability, not for restoring muscle function in cases of paralysis.
Question 19: A 65-year-old lady presented with a swollen and painful knee. On examination, she was found to have grade III osteoarthritic changes. What is the best course of action?
- A. Conservative management
- B. Total knee replacement (Correct Answer)
- C. Arthroscopic washing
- D. Partial knee replacement
Explanation: ***Total knee replacement*** - For **grade III osteoarthritis** in a 65-year-old, a total knee replacement is the most definitive and effective treatment to relieve pain and restore function in a severely damaged joint. - This procedure addresses widespread cartilage loss and structural changes typical of advanced osteoarthritis. *Conservative management* - This approach is typically favored for **mild to moderate osteoarthritis**, involving physical therapy, NSAIDs, and lifestyle modifications. - For **grade III changes** with significant pain and swelling, conservative measures are unlikely to provide sufficient relief or halt disease progression effectively. *Arthroscopic washing* - **Arthroscopic lavage** and debridement are rarely recommended for osteoarthritis as they have not shown sustained benefits for pain or function. - It is sometimes used for specific mechanical symptoms, but it does not address the underlying cartilage loss and structural damage in severe osteoarthritis. *Partial knee replacement* - A **partial knee replacement** is suitable when osteoarthritis is confined to a single compartment of the knee, and the other compartments are healthy. - Given the indication of "grade III osteoarthritic changes" without specifying a single compartment, a total knee replacement is generally more appropriate for widespread disease.
Question 20: What is the most common complication after total hip replacement?
- A. Dislocation
- B. DVT (Correct Answer)
- C. Infection
- D. Aseptic Loosening
Explanation: ***DVT*** - Deep vein thrombosis (DVT) is the **most common overall complication** following total hip replacement, with reported incidences as high as 40-60% without prophylaxis. - The risk of DVT is significant due to **venous stasis during surgery**, immobilization, and the inflammatory response to tissue injury. *Dislocation* - While a serious complication, **dislocation** of the prosthetic hip joint is less common than DVT, occurring in about 1-5% of primary total hip replacements. - It typically results from **improper joint positioning** or patient activities that push the hip beyond its normal range of motion. *Infection* - **Infection** is a severe but relatively rare complication, with rates for periprosthetic joint infection in total hip replacement typically ranging from 0.5% to 2%. - It can lead to significant morbidity and usually requires **further surgical intervention** for eradication. *Aseptic Loosening* - **Aseptic loosening** is a long-term complication, occurring years after the surgery, rather than an immediate post-operative complication. - This complication involves the **failure of the implant-bone interface** without evidence of infection, often due to particle disease or mechanical stress.
Question 21: A 65-year-old presents with chronic knee pain, varus deformity, and medial joint space narrowing. BMI is 32. Best treatment option?
- A. Arthroscopic Debridement
- B. Unicompartmental Knee Replacement
- C. High Tibial Osteotomy
- D. Total Knee Replacement (Correct Answer)
Explanation: ***Total Knee Replacement*** - This is the most appropriate treatment for a 65-year-old with chronic knee pain, significant **varus deformity**, and **medial joint space narrowing**, indicative of advanced **osteoarthritis**. - A **high BMI (32)** is also a factor that often points towards the need for total joint replacement when conservative measures have failed, as it contributes to increased stress on the knee. *Arthroscopic Debridement* - This procedure is generally reserved for less severe osteoarthritis symptoms or mechanical symptoms like locking, and it is **not effective** for advanced joint degeneration with significant deformity. - It would provide little to no long-term benefit for the presented severe changes and chronic pain. *Unicompartmental Knee Replacement* - While suitable for isolated medial compartment osteoarthritis, a **varus deformity** indicates damage beyond a single compartment or significant malalignment that might not be fully corrected by a unicompartmental approach. - The chronicity, age, and likely degree of degeneration suggest a more comprehensive solution is needed. *High Tibial Osteotomy* - This procedure is typically performed in younger, more active patients with **varus malalignment** and early to moderate osteoarthritis to shift weight to a healthier compartment. - At 65 years old with chronic pain and advanced joint space narrowing, a **corrective osteotomy** is less likely to provide long-term relief and may delay a more definitive solution.
Question 22: Why is early mobilization important after hip arthroplasty?
- A. Prevents joint stiffness
- B. Prevents DVT
- C. Reduces hospital stay
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - Early mobilization is crucial following hip arthroplasty as it offers a multifaceted approach to recovery, addressing **joint stiffness**, the risk of **DVT**, and the duration of **hospital stay**. - This comprehensive benefit highlights the importance of an integrated approach to postoperative care. *Prevents joint stiffness* - While early mobilization helps prevent joint stiffness, it is not the sole benefit, as it also addresses other critical postoperative complications. - Restricted movement in the initial postoperative period can lead to adhesions and **contractures**, limiting the long-term range of motion. *Prevents DVT* - Preventing **deep vein thrombosis (DVT)** is a significant benefit of early mobilization, but it represents only one aspect of its overall importance. - Immobility post-surgery increases the risk of blood clot formation due to venous stasis, making active movement essential. *Reduces hospital stay* - Reducing the length of hospital stay is a key advantage of early mobilization, but it's part of a broader set of benefits that contribute to faster recovery and better outcomes. - Expedited discharge is often a direct result of improved patient mobility, reduced complication rates, and enhanced surgical recovery.
Question 23: A 75-year-old man presents with a fracture of the intracapsular neck of the femur. What is the most common management option for this patient?
- A. Hemiarthroplasty (Correct Answer)
- B. Total Hip Replacement
- C. Dynamic Hip Screw
- D. Conservative Management
Explanation: **Hemiarthroplasty** - **Hemiarthroplasty** is the most common management for **intracapsular neck of femur fractures** in elderly patients, especially those who are frail or have substantial comorbidities. - This procedure replaces the **femoral head** with a prosthesis, preserving the native acetabulum, which is sufficient given the higher risk of complications with a full replacement in this age group. *Total Hip Replacement* - **Total hip replacement (THR)** is typically reserved for more active elderly patients with **pre-existing osteoarthritis** or for those requiring revision surgery, due to better functional outcomes but higher surgical risks. - It involves replacing both the **femoral head** and the **acetabulum**, *Dynamic Hip Screw* - A **dynamic hip screw (DHS)** is primarily used for **extracapsular femur fractures** (e.g., trochanteric fractures), where the blood supply to the femoral head is largely preserved. - It involves fixation, which is not suitable for most **intracapsular fractures** due to the disruption of blood supply, increasing the risk of **avascular necrosis** and non-union. *Conservative Management* - **Conservative management** (e.g., bed rest, pain control) is generally not recommended for **intracapsular neck of femur fractures** in mobile elderly patients due to high rates of complications such as **deep vein thrombosis**, **pressure ulcers**, and **avascular necrosis**. - It may be considered only in patients who are **non-ambulatory** or have severe contraindications to surgery.
Question 24: A 70-year-old woman with chronic osteoarthritis of the hip presents with worsening pain and limited mobility despite conservative management. What is the next appropriate step?
- A. NSAIDs
- B. Physical therapy
- C. Intra-articular corticosteroid injections
- D. Total hip replacement (Correct Answer)
Explanation: ***Total hip replacement*** - For **severe osteoarthritis (OA)** causing significant pain and **functional impairment** despite failed conservative management, **total hip replacement** is the most definitive and effective treatment. - This procedure alleviates pain and restores **mobility**, dramatically improving the patient's quality of life. *NSAIDs* - **NSAIDs** are typically part of **initial conservative management** for symptomatic relief in mild to moderate OA, but they have already failed in this patient. - Continued use in elderly patients carries risks of **gastrointestinal, renal, and cardiovascular side effects**, making it a less desirable long-term solution. *Physical therapy* - **Physical therapy** is a crucial component of conservative management to improve **strength, flexibility, and function**, but it often becomes insufficient in advanced OA. - Since this patient has worsening symptoms despite conservative measures, physical therapy alone is unlikely to provide adequate relief. *Intra-articular corticosteroid injections* - **Corticosteroid injections** can provide temporary pain relief by reducing inflammation but do not address the underlying **structural damage** of severe OA. - Their effectiveness diminishes over time, and repeated injections are discouraged due to potential cartilage damage.
Question 25: What is the primary indication for total hip replacement in osteoarthritis?
- A. Failed conservative treatment (Correct Answer)
- B. Hip dysplasia
- C. Intertrochanteric fractures
- D. Unstable pelvic fractures
Explanation: ***Failed conservative treatment*** - Total hip replacement (THR) is typically reserved for severe **osteoarthritis** where **non-surgical interventions** like pain medication, physical therapy, and lifestyle modifications no longer provide adequate pain relief or functional improvement. - This option reflects the standard clinical pathway in managing chronic joint degenerative conditions, emphasizing that surgery is a last resort after exhausting less invasive treatments. *Hip dysplasia* - While hip dysplasia can lead to osteoarthritis over time, it is a developmental condition, and its primary treatment in younger individuals might involve osteotomy to correct the abnormal hip structure, rather than immediate THR. - THR is used for hip dysplasia only if it has progressed to severe osteoarthritis and conservative management has failed. *Intertrochanteric fractures* - **Intertrochanteric fractures** of the femur are typically treated with internal fixation (e.g., intramedullary nail or dynamic hip screw) or hemiarthroplasty, depending on the fracture pattern and patient's age and co-morbidities. - Total hip replacement may be considered in a select group of patients with severe comminution involving the femoral head or pre-existing severe osteoarthritis, but it is not the primary indication for these fractures. *Unstable pelvic fractures* - **Unstable pelvic fractures** are acute traumatic injuries that require urgent surgical stabilization, often with external fixation or open reduction and internal fixation. - These fractures are not managed with total hip replacement, which is an elective procedure for chronic degenerative joint disease.
Question 26: What is the most important factor to consider when choosing between total hip replacement and hemiarthroplasty for a geriatric patient with a fragility fracture of the hip?
- A. The cheapest available option
- B. Surgeon's preference for procedure type
- C. Availability of prosthetics
- D. Bone quality of the patient (Correct Answer)
Explanation: ***Bone quality of the patient*** - **Bone quality**, particularly the presence of **osteoporosis**, is crucial as it determines the stability and longevity of the implant in both procedures. **Poor bone quality** can compromise the fixation of the prosthesis, influencing the choice of implant and surgical technique to prevent complications like loosening or periprosthetic fractures. - While both procedures address the fracture, the decision often hinges on the patient's **pre-existing functional status**, **activity level**, and **acetabular cartilage health**. For patients with good acetabular cartilage and a desire for higher function, total hip replacement might be considered, but **bone quality** remains a foundational consideration for implant success. *The cheapest available option* - The **cost** of the procedure should not be the primary determinant in choosing a surgical intervention, especially in cases where optimizing patient outcomes and minimizing complications are paramount. - Prioritizing cost over clinically indicated options can lead to suboptimal outcomes, increased revision rates, and higher long-term healthcare expenditures. *Surgeon's preference for procedure type* - While a surgeon's experience and expertise are important, the decision should be based on **patient-specific factors** and evidence-based guidelines, not solely on personal preference. - Relying solely on **surgeon's preference** without considering individual patient needs and clinical evidence may compromise the optimal treatment plan. *Availability of prosthetics* - While practical, the **availability of specific prosthetics** should not override the clinical decision based on patient physiology and anticipated functional demands. - Decisions should ideally be based on what is best for the patient, with efforts made to resource appropriate implants rather than being limited by immediate stock.
Question 27: Which surgical technique is indicated for a 60-year-old patient with severe arthritis and imaging that shows extensive hip joint damage?
- A. Arthroscopic debridement
- B. Total hip replacement (Correct Answer)
- C. Osteotomy
- D. Steroid joint injection
Explanation: ***Total hip replacement*** - For **severe arthritis** and extensive hip joint damage in a 60-year-old, total hip replacement is the most definitive surgical solution to **relieve pain** and restore function. - This procedure involves removing damaged bone and cartilage and replacing them with **prosthetic components**. *Arthroscopic debridement* - This is a minimally invasive procedure, but it is typically reserved for **mild to moderate arthritis** or to address specific mechanical problems like loose bodies, not extensive damage. - It does not address widespread cartilage loss or significant joint degeneration. *Osteotomy* - An osteotomy involves surgically **realigning bones** to shift weight from damaged areas to healthier cartilage. - It's generally considered for younger patients with **early-stage arthritis** or specific deformities, not typically for severe, extensive damage in an older patient. *Steroid joint injection* - Steroid injections are **palliative treatments** aimed at reducing inflammation and pain. - They provide **temporary relief** and do not repair or replace damaged joint structures, making them unsuitable for extensive damage requiring surgical intervention.
Question 28: A 30-year-old patient presents with right hip pain. An X-ray shows an avascular femoral head. What is the best treatment option for this condition if the patient has a collapsed femoral head with acetabular involvement?
- A. Core decompression
- B. Total hip replacement (Correct Answer)
- C. Bone marrow transplantation
- D. Non-weight bearing exercises
Explanation: ***Total hip replacement*** - A **collapsed femoral head** with **acetabular involvement** indicates advanced avascular necrosis, making reconstructive options like total hip replacement the most effective treatment. - This procedure alleviates pain and restores function by replacing the damaged joint surfaces with prosthetic components, which is crucial for patients with significant structural damage and symptoms. *Core decompression* - This procedure is primarily considered for **early stages** of avascular necrosis, before significant collapse of the femoral head. - It aims to reduce intraosseous pressure and promote revascularization, but it is less effective once the femoral head has already collapsed and the acetabulum is involved. *Bone marrow transplantation* - Bone marrow transplantation (specifically **autologous concentrated bone marrow aspirate**) can be used as an adjuvant therapy in earlier stages of avascular necrosis to promote healing, but it is not a primary treatment for a collapsed femoral head with acetabular involvement. - This option does not address the structural failure of the joint that has already occurred. *Non-weight bearing exercises* - While **non-weight-bearing** is often advised in early avascular necrosis to reduce stress on the hip, it is a conservative measure and will not reverse the damage of a collapsed femoral head or resolve acetabular involvement. - This approach mainly focuses on preventing further progression rather than treating established severe damage.
Question 29: A 68-year-old female with a history of osteoporosis presents with a hip fracture and is scheduled for hemiarthroplasty. What intraoperative strategies are critical to minimizing the risk of complications?
- A. Choice of cemented vs. uncemented prosthesis, blood loss management, and perioperative antibiotic prophylaxis (Correct Answer)
- B. Speed of the surgery
- C. Patient’s dietary habits
- D. Use of the least expensive prosthesis
Explanation: ***Choice of cemented vs. uncemented prosthesis, blood loss management, and perioperative antibiotic prophylaxis*** - Selecting between **cemented and uncemented prostheses** depends on bone quality (osteoporosis often favors cemented to ensure fixation), while **meticulous blood loss management** is crucial in elderly patients with limited physiological reserve. - **Perioperative antibiotic prophylaxis** is paramount to prevent surgical site infections, a common and severe complication in orthopedic surgery. *Speed of the surgery* - While prolonged surgical time can increase complication risk, simply focusing on "speed" without considering other critical factors is an **over-simplification**. - Rushing can lead to errors and inadequate surgical technique, potentially causing more complications than a carefully executed, albeit slightly longer, procedure. *Patient’s dietary habits* - Dietary habits are important for **overall patient health and recovery**, but they are not intraoperative strategies directly affecting the surgical complications. - Nutritional status is a **preoperative consideration** that influences healing, but it doesn't represent an intraoperative decision point. *Use of the least expensive prosthesis* - Cost-effectiveness is a consideration in healthcare, but it should not dictate critical intraoperative decisions like prosthesis choice, especially when patient safety and optimal outcomes are at stake. - Choosing a prosthesis based solely on **cost over clinical suitability** can lead to suboptimal outcomes and higher complication rates.
Question 30: During performing a total hip replacement, the surgeon found destruction of the articular cartilage and multiple wedge-shaped subchondral depressions. What is this called?
- A. Osteolysis
- B. Osteomyelitis
- C. Osteonecrosis (Correct Answer)
- D. Osteogenesis
Explanation: ***Osteonecrosis*** - **Osteonecrosis**, also known as **avascular necrosis**, is characterized by the death of bone tissue due to a lack of blood supply, which leads to the collapse of the subchondral bone and articular cartilage destruction. - The description of **wedge-shaped subchondral depressions** and **articular cartilage destruction** is highly indicative of osteonecrosis, especially in the context of advanced hip joint pathology requiring total hip replacement. *Osteolysis* - **Osteolysis** refers to the active resorption of bone, often seen around implants in prosthetic joints due to wear particles, leading to bone loss. - While it involves bone destruction, it typically presents as diffuse bone loss rather than specific wedge-shaped subchondral depressions. *Osteomyelitis* - **Osteomyelitis** is an infection of the bone or bone marrow, often leading to bone destruction, but it is primarily characterized by inflammation and pus formation. - The presented scenario does not mention signs of infection (e.g., fever, pus, inflammation) but focuses purely on structural destruction consistent with vascular compromise. *Osteogenesis* - **Osteogenesis** is the process of bone formation or development. - This term describes the creation of bone tissue and is the opposite of bone destruction, making it an incorrect answer for a condition involving cartilage and bone deterioration.
Question 31: Who is often referred to as the father of joint replacement surgery?
- A. Sir John Manning
- B. Sir John Charnley (Correct Answer)
- C. Dr. Ignacio Ponseti
- D. Sir John Girdlestone
Explanation: ***Sir John Charnley*** - **Sir John Charnley** is widely recognized as the **father of modern hip replacement surgery** due to his pioneering work in developing low-friction arthroplasty in the 1960s. - He introduced concepts such as **bone cement fixation**, **aseptic operating environments**, and the use of **ultra-high molecular weight polyethylene** as a bearing surface. *Sir John Manning* - While significant in medical history, **Sir John Manning** is not associated with the development of joint replacement surgery. - His contributions do not primarily lie in orthopedic surgery innovations. *Dr. Ignacio Ponseti* - **Dr. Ignacio Ponseti** is renowned for developing the **Ponseti method** for the treatment of **clubfoot**, a non-surgical technique involving manipulation and casting. - His work focuses on pediatric orthopedics and congenital deformities rather than joint replacement. *Sir John Girdlestone* - **Sir John Girdlestone** is known for the **Girdlestone arthroplasty**, a salvage procedure involving the **excision of the femoral head** to treat severe hip infections or failed hip replacements. - This procedure aims to create a pseudoarthrosis rather than replacing the joint, distinguishing it from modern joint replacement.
Question 32: Treatment of choice for displaced fracture neck femur in a 40 years old female
- A. None of the options
- B. Bipolar hemiarthroplasty
- C. Multiple screw fixation (Correct Answer)
- D. THR
Explanation: ***Multiple screw fixation*** - For a **displaced femoral neck fracture** in a younger patient (40 years old), **internal fixation** with multiple screws is generally the preferred treatment to preserve the native **femoral head**. - This approach aims to achieve **anatomical reduction** and stable fixation, allowing for bone healing and a better long-term functional outcome in active individuals. *Bipolar hemiarthroplasty* - This procedure is typically reserved for older, less active patients with **displaced femoral neck fractures**, particularly those with pre-existing conditions that might limit their longevity or activity level. - While it replaces the femoral head, it does not preserve the native joint, which is a less desirable outcome in a 40-year-old. *THR* - **Total hip replacement** is usually considered for older patients, or younger patients with **pre-existing arthritis** or failed internal fixation, due to concerns about the prosthesis's longevity and potential future revisions. - In a 40-year-old, the goal is typically to preserve the native joint if possible, unless there are other complicating factors. *None of the options* - Internal fixation with multiple screws is a well-established and appropriate treatment for a displaced femoral neck fracture in a 40-year-old patient. - Therefore, one of the provided options is indeed the correct treatment choice for this specific scenario.
Question 33: After chronic use of steroids, a patient presents with severe pain in the right hip and immobility. What is the most likely diagnosis?
- A. Avascular necrosis (Correct Answer)
- B. Hip dislocation
- C. Osteoarthritis
- D. Perthes disease
Explanation: ***Avascular necrosis*** - Chronic **steroid use** is a major risk factor for avascular necrosis (AVN), particularly affecting the **femoral head**, leading to severe hip pain and immobility. - AVN occurs due to the death of bone tissue resulting from an **interruption of blood supply**, often manifesting as pain that worsens with weight-bearing. *Perthes disease* - This condition is a form of avascular necrosis of the femoral head, but it primarily affects **children**, typically between 4 and 10 years old. - The patient's age (adult) makes Perthes disease an unlikely diagnosis. *Hip dislocation* - Hip dislocation presents with **acute, severe pain** and an inability to bear weight, often following significant trauma. - There is no mention of trauma, and the patient has a history of chronic steroid use, which is not a direct cause of hip dislocation. *Osteoarthritis* - While osteoarthritis causes hip pain and stiffness, it typically develops **gradually** and is associated with aging, obesity, or previous joint injury. - The acute, severe pain after chronic steroid use is more characteristic of avascular necrosis.
Question 34: The treatment of choice for a 65-year-old man who presented with a fracture of the neck of femur three days after injury is:
- A. Multiple screw fixation
- B. Mc-Murray osteotomy
- C. Total hip replacement
- D. Hemiarthroplasty (Correct Answer)
Explanation: ***Hemiarthroplasty*** - For a 65-year-old patient with a **femoral neck fracture** recognized three days post-injury, **hemiarthroplasty** is the treatment of choice due to the high risk of **avascular necrosis** (AVN) of the femoral head and non-union. - The delay in presentation increases the likelihood of compromised blood supply to the femoral head, making internal fixation less reliable. *Multiple screw fixation* - This method is typically preferred for **younger patients** (under 60-65 years) with femoral neck fractures where the blood supply to the femoral head is still largely preserved. - The three-day delay and the patient's age in this case significantly increase the risk of **femoral head avascular necrosis**, making internal fixation unsuitable. *Mc-Murray osteotomy* - **McMurray osteotomy** is an older procedure primarily used for treating **osteoarthritis of the hip** or non-union of femoral neck fractures in active individuals, rather than as an acute treatment for a fresh fracture. - It involves reshaping the bone to shift weight-bearing forces and is not indicated for the immediate management of a femoral neck fracture in a 65-year-old. *Total hip replacement* - While a **total hip replacement** (THR) is an excellent option for older, more active patients with femoral neck fractures or severe osteoarthritis, it is generally considered a more extensive surgery with a higher risk of complications compared to hemiarthroplasty for this patient profile. - **Hemiarthroplasty** is often favored for elderly patients with lower functional demands and higher morbidity risks, as it offers quicker recovery and less operative time, addressing the acute fracture effectively.
Practice by Chapter
Principles of Joint Replacement
Practice Questions
Total Hip Arthroplasty
Practice Questions
Total Knee Arthroplasty
Practice Questions
Shoulder Arthroplasty
Practice Questions
Elbow Arthroplasty
Practice Questions
Ankle Arthroplasty
Practice Questions
Revision Arthroplasty
Practice Questions
Implant Materials and Design
Practice Questions
Complications of Arthroplasty
Practice Questions
Infected Arthroplasty Management
Practice Questions
Rehabilitation After Arthroplasty
Practice Questions
Long-term Outcomes and Surveillance
Practice Questions
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