Future Trends in Computer-Assisted Orthopaedics — MCQs
What is the condition commonly known as jumper's knee?
Gold standard investigation for breast carcinoma screening in a patient with silicone breast implants
In which of the following situations is breast conservation surgery not indicated?
All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:
Which technique is considered the best for evaluating bone regeneration after periodontal surgery?
Vacuum assisted closure is contraindicated in which of the following conditions -
What does the given image show?
A surgeon experiences pin-site fracture during reference array fixation in computer-navigated TKA in an osteoporotic patient. Subsequently, three more cases develop similar complications. What systematic approach should be implemented to prevent this complication?
A tertiary care center is planning to implement computer-assisted surgery program for joint replacement. They have limited budget and expertise. Which factor should be prioritized when selecting a navigation system?
A study compares outcomes of computer-navigated versus conventional total knee arthroplasty. Navigation group shows 95% implants within 3 degrees of neutral mechanical axis versus 80% in conventional group (p<0.05). However, 5-year functional outcomes and survival rates are similar. What is the most appropriate interpretation?
Future Trends in Computer-Assisted Orthopaedics Indian Medical PG Practice Questions and MCQs
Question 1: What is the condition commonly known as jumper's knee?
- A. Inflammation of the patellar tendon at its insertion on the patella.
- B. Tendinopathy of the quadriceps tendon.
- C. Injury to the hamstring tendon.
- D. Patellar tendonitis due to overuse of the patellar tendon. (Correct Answer)
Explanation: ***Patellar tendonitis due to overuse of the patellar tendon.*** - **Jumper's knee** is the common term for **patellar tendonitis**, which specifically refers to inflammation of the patellar tendon. - This condition is frequently caused by **overuse**, especially in activities involving repetitive jumping and landing. *Inflammation of the patellar tendon at its insertion on the patella.* - While jumper's knee does involve inflammation of the patellar tendon, it is more commonly at its insertion on the **tibial tubercle** or specifically its origin at the **inferior pole of the patella**, not necessarily at the patella itself. - This option is less precise as it describes only one aspect of the condition without mentioning the critical role of overuse. *Tendinopathy of the quadriceps tendon.* - **Tendinopathy of the quadriceps tendon** is a distinct condition affecting the tendon above the patella, known as **quadriceps tendinopathy**. - It presents with pain proximal to the patella, differentiating it from jumper's knee, which involves the tendon distal to the patella. *Injury to the hamstring tendon.* - An **injury to the hamstring tendon** would cause pain and symptoms on the posterior aspect of the knee or thigh. - This is completely unrelated to jumper's knee, which is characterized by anterior knee pain.
Question 2: Gold standard investigation for breast carcinoma screening in a patient with silicone breast implants
- A. Mammography
- B. CT scan
- C. USG
- D. MRI (Correct Answer)
Explanation: ***MRI*** - **MRI** is considered the **gold standard** for breast cancer screening in patients with silicone breast implants due to its superior ability to visualize breast tissue through the implant and detect subtle lesions. - It offers **high sensitivity** in detecting both implant rupture and early malignancies, often providing better clarity than mammography in augmented breasts where implants can obscure tissue. *Mammography* - While a standard screening tool, **mammography** can be limited in patients with silicone implants because the implants can **obscure adjacent breast tissue**, making detection of small masses challenging. - Special views (e.g., **Eklund views**) can be used, but sensitivity is still reduced compared to MRI in augmented breasts. *CT scan* - **CT scans** are not routinely used for primary breast cancer screening due to their use of **ionizing radiation** and lower sensitivity for detecting early breast lesions compared to MRI. - CT is more commonly used for **staging** advanced cancers or evaluating complex masses detected by other modalities. *USG* - **Ultrasound (USG)** is a valuable complementary tool, especially for evaluating palpable lumps or clarifying findings from mammography, but it is **operator-dependent** and has a lower overall sensitivity for general screening compared to MRI. - It is particularly useful for differentiating between **cystic and solid masses** and detecting implant ruptures but is not the gold standard for comprehensive screening in augmented breasts.
Question 3: In which of the following situations is breast conservation surgery not indicated?
- A. SLE
- B. Large pendular breast
- C. Diffuse microcalcification
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - All listed scenarios—**large pendular breast**, **SLE**, and **diffuse microcalcification**—represent situations where breast conservation surgery is generally contraindicated or challenging. - Their presence often necessitates alternative treatment approaches, such as mastectomy, to achieve optimal oncologic and cosmetic outcomes. *Large pendular breast* - While not an absolute contraindication, a **very large or pendulous breast** can make it difficult to achieve a satisfactory cosmetic outcome after breast conservation surgery. - The disproportionate breast size post-lumpectomy may lead to significant **asymmetry**, requiring further reconstructive procedures. *SLE* - Patients with **Systemic Lupus Erythematosus (SLE)** are at an increased risk of complications from radiation therapy, a mandatory component of breast conservation surgery. - They tend to experience more severe and prolonged **acute and chronic skin reactions** to radiation, which can significantly impair healing and quality of life. *Diffuse microcalcification* - **Diffuse microcalcification** within the breast can indicate widespread in situ carcinoma (e.g., DCIS) or an invasive carcinoma with extensive intraductal component. - In such cases, achieving **clear surgical margins** with breast conservation surgery can be challenging and often leads to multiple re-excisions or an increased risk of local recurrence.
Question 4: All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:
- A. Multiple trauma
- B. Stable closed fracture (Correct Answer)
- C. Compound fracture
- D. Intra-articular fracture
Explanation: ***Stable closed fracture*** - A **stable closed fracture** typically does not require surgical intervention with ORIF as it can usually be managed non-surgically with casting or bracing. - The goal of ORIF is to achieve **anatomic reduction and rigid fixation**, which is not necessary for stable fractures that maintain alignment. *Multiple trauma* - In patients with **multiple trauma**, early stabilization of long bone fractures using ORIF can help reduce pain, prevent further injury, and facilitate patient mobilization. - This approach aims to reduce the risk of complications such as **ARDS (acute respiratory distress syndrome)** and fat embolism for critically ill patients. *Compound fracture* - **Compound (open) fractures** involve a break in the skin, exposing the bone to the external environment, and are a classic indication for surgical management. - ORIF in these cases helps to achieve **stabilization** after debridement, crucial for preventing infection and promoting bone healing. *Intra-articular fracture* - **Intra-articular fractures** involve the joint surface, and accurate anatomical reduction is critical to prevent post-traumatic arthritis and preserve joint function. - ORIF provides the precise reduction and stable fixation needed to restore the **joint congruity**.
Question 5: Which technique is considered the best for evaluating bone regeneration after periodontal surgery?
- A. Intraoral Periapical radiography
- B. Orthopantomogram
- C. Digital subtraction radiography
- D. Cone Beam Computed Tomography (Correct Answer)
Explanation: ***Cone Beam Computed Tomography*** - **CBCT** offers a three-dimensional view, which is superior for assessing **bone density, volume**, and the precise morphology of bone regeneration. - It allows for detailed analysis of defects and regeneration without the superimposition of anatomical structures, which is a limitation of 2D radiographs. *Intraoral Periapical radiography* - **Periapical radiographs** provide only a two-dimensional image and are poor at differentiating between **bony infill** and soft tissue. - They are limited by projection geometry and cannot accurately represent **bone volume** or complex defects. *Orthopantomogram* - An **OPG** provides a panoramic view but suffers from significant **magnification, distortion**, and superimposition of structures. - It is not precise enough for the detailed assessment required to evaluate **bone regeneration** after periodontal surgery. *Digital subtraction radiography* - **Digital subtraction radiography** can detect subtle changes in bone mineral content by subtracting two images taken at different times. - While useful for showing small changes, it is still a **2D technique** and does not provide information on **bone volume** or the three-dimensional architecture of the regenerated bone.
Question 6: Vacuum assisted closure is contraindicated in which of the following conditions -
- A. Chronic osteomyelitis
- B. Large amount of necrotic tissue with eschar (Correct Answer)
- C. Abdominal wound
- D. Surgical wound dehiscence
Explanation: ***Large amount of necrotic tissue with eschar*** - The presence of a large amount of **necrotic tissue** and **eschar** is a contraindication for VAC therapy because it prevents effective contact between the foam and viable tissue, impairing wound healing. - Eschar acts as a physical barrier, trapping bacteria and hindering the proper function of negative pressure by preventing uniform pressure distribution and fluid removal from the wound bed. *Chronic osteomyelitis* - While chronic osteomyelitis can be challenging, VAC therapy can sometimes be used as an **adjunctive treatment** after surgical debridement to manage the wound and promote granulation tissue formation. - It helps in controlling infection and closing the wound by removing exudates, reducing edema, and improving blood flow. *Abdominal wound* - VAC therapy is commonly used for **abdominal wounds**, especially after damage control surgery or in cases of open abdomen management. - It facilitates closure by promoting granulation, reducing edema, and protecting the abdominal contents. *Surgical wound dehiscence* - **Surgical wound dehiscence** is a common indication for VAC therapy, as it helps to manage the open wound, promote granulation tissue, and prepare the wound for eventual secondary closure or grafting. - VAC therapy reduces surgical site infections, removes exudates, and enhances tissue perfusion, leading to better wound healing outcomes.
Question 7: What does the given image show?
- A. Doyen's periosteal elevator (Correct Answer)
- B. Cobb's spinal elevator
- C. Leksell's rongeur
- D. Key periosteal elevator
Explanation: ***Doyen's periosteal elevator*** - This instrument is characterized by its **curved, spoon-like working end** and solid handle, designed for **elevating the periosteum** from bone. - Doyen's elevator comes in various sizes and angles, but the distinct hook-like curve is a key identifying feature, distinguishing it from other elevators. *Cobb's spinal elevator* - Cobb's elevator typically has a **flat, broad, and slightly curved blade** with a rounded or tapered tip, suitable for dissecting along bony surfaces, particularly in spinal surgery. - Its design prioritizes broad, even separation of tissue layers, contrasting with the more acute curve of the Doyen's. *Leksell's rongeur* - A rongeur is a biting instrument used for **gnawing away bone or tough tissue**, characterized by hinged jaws with sharp, cup-shaped ends. - The image clearly shows a single-piece instrument without hinged jaws, ruling out a rongeur. *Key periosteal elevator* - The Key elevator typically features a **broader, more rounded or slightly angled tip** and a flat, somewhat spatula-like working end, used for general periosteal elevation. - While also a periosteal elevator, its working end does not exhibit the characteristic deep, hook-like curve seen in the Doyen's elevator.
Question 8: A surgeon experiences pin-site fracture during reference array fixation in computer-navigated TKA in an osteoporotic patient. Subsequently, three more cases develop similar complications. What systematic approach should be implemented to prevent this complication?
- A. Switch to electromagnetic navigation system
- B. Use unicortical pins instead of bicortical pins with reduced insertion torque protocol (Correct Answer)
- C. Abandon navigation in all osteoporotic patients
- D. Increase pin diameter for better fixation
Explanation: ***Use unicortical pins instead of bicortical pins with reduced insertion torque protocol*** - **Pin-site fractures** are a known complication in navigated TKA, especially in **osteoporotic bone**, and can be mitigated by reducing the **stress risers** created by drilling. - Using **unicortical pins** and avoiding power drivers to limit **insertion torque** provides sufficient stability for reference arrays while minimizing the risk of cortical failure. *Switch to electromagnetic navigation system* - **Electromagnetic navigation** aims to resolve line-of-sight issues but does not inherently eliminate the need for stable skeletal fixation of reference sensors. - Switching systems is a costly equipment change that does not directly address the underlying **biomechanical failure** of the bone-pin interface in osteoporosis. *Abandon navigation in all osteoporotic patients* - Abandoning navigation denies the patient population the benefits of **precise alignment** and component positioning where it is often most needed due to poor bone quality. - Systematic technical modifications are preferred over total abandonment of a beneficial **surgical technology**. *Increase pin diameter for better fixation* - Increasing the **pin diameter** is counterproductive as larger holes create larger **stress concentrators**, significantly increasing the risk of **periprosthetic fracture** in brittle bone. - A thicker pin displaces more cortical volume, which reduces the **structural integrity** of the femur or tibia in osteoporotic patients.
Question 9: A tertiary care center is planning to implement computer-assisted surgery program for joint replacement. They have limited budget and expertise. Which factor should be prioritized when selecting a navigation system?
- A. Image-based system requiring dedicated CT scanner
- B. Imageless navigation with good technical support and training program (Correct Answer)
- C. Most expensive system with all features available
- D. System with steepest learning curve to ensure only expert surgeons use it
Explanation: ***Imageless navigation with good technical support and training program*** - **Imageless navigation** is the most cost-effective choice for limited budgets as it avoids the preoperative costs and infrastructure associated with **CT scans** or dedicated imaging. - Prioritizing **technical support** and **training programs** is essential for overcoming the **learning curve** (typically 15-20 cases) in a center with limited initial expertise. *Image-based system requiring dedicated CT scanner* - These systems increase the **per-case cost** and require significant capital investment in preoperative **CT imaging** infrastructure. - They introduce additional **radiation exposure** to the patient and complex logistics that may not suit a center with limited resources. *Most expensive system with all features available* - Purchasing the most expensive system is counterproductive for a facility with a **limited budget**, as many advanced features may not be utilized during the initial phase. - High-cost systems often have higher **maintenance contracts** and operational costs that can lead to program failure in resource-constrained environments. *System with steepest learning curve to ensure only expert surgeons use it* - A **steep learning curve** is a major barrier to the adoption of new technology and can lead to increased **operation time** and operative complications. - The goal of implementing a new program should be **sustainable integration** and broad clinical utility rather than restricting access through technical difficulty.
Question 10: A study compares outcomes of computer-navigated versus conventional total knee arthroplasty. Navigation group shows 95% implants within 3 degrees of neutral mechanical axis versus 80% in conventional group (p<0.05). However, 5-year functional outcomes and survival rates are similar. What is the most appropriate interpretation?
- A. Navigation is inferior due to longer operative time without functional benefit
- B. Conventional technique should be abandoned
- C. Improved radiographic alignment may not translate to short-term functional improvement but could affect long-term survival (Correct Answer)
- D. The study proves navigation provides no clinical benefit
Explanation: ***Improved radiographic alignment may not translate to short-term functional improvement but could affect long-term survival*** - Navigation significantly improves **radiographic alignment** consistency (p<0.05), but high-quality evidence shows this does not always create immediate **functional differences** within 5 years. - While **short-term functional outcomes** are similar, reducing **outliers** to within 3 degrees of the neutral axis is theoretically linked to better **implant survival** beyond 10-15 years. *Navigation is inferior due to longer operative time without functional benefit* - Increased **operative time** is a known drawback, but it does not make the technique **inferior** if it achieves superior technical precision. - The term "inferior" is clinically inaccurate here as the study demonstrates **statistically significant** improvements in surgical accuracy. *Conventional technique should be abandoned* - **Conventional techniques** are still the gold standard because they provide identical **short-term survival** and clinical scores at a lower cost. - Abandonment is unjustified as long as the **clinical outcome** parity exists and long-term superiority of navigation is not yet definitively proven by this data. *The study proves navigation provides no clinical benefit* - Improved **mechanical axis** alignment is itself a technical clinical benefit that reduces mechanical stress on the polyethene liner. - A lack of difference in **5-year scores** does not prove a lack of benefit; it only indicates that **short-term follow-up** may be insufficient to detect long-term wear advantages.
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