Robotic Surgery in Orthopaedics — MCQs
Severe disability in primary osteoarthritis of hip is best managed by -
What is the best imaging modality for detecting early osteomyelitis?
The most common approach for total hip arthroplasty is
Myodesis is employed in amputations for all of the following indications except:
What is the most common complication after total hip replacement?
Patellar tendon-bearing P.O.P. cast is indicated in the following fracture:
Watson Jones Operation is the procedure for which of the following conditions?
Surgery was performed as shown in the image below. What is the name of the procedure?
All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:
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?
Robotic Surgery in Orthopaedics Indian Medical PG Practice Questions and MCQs
Question 1: 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 2: What is the best imaging modality for detecting early osteomyelitis?
- A. CT scan
- B. X-ray
- C. MRI (Correct Answer)
- D. Bone scintigraphy
Explanation: ***MRI*** - **Magnetic Resonance Imaging (MRI)** is considered the **gold standard** for detecting early osteomyelitis due to its excellent soft tissue contrast and ability to visualize **bone marrow edema**, which is an early sign of infection. - It can identify changes within **3-5 days** of infection onset, much earlier than other modalities. *CT scan* - While useful for showing **bone destruction**, cortical integrity, and sequestra, **CT scans** are less sensitive than MRI for detecting early marrow edema. - Its ability to diagnose osteomyelitis is usually delayed until significant **bony changes** have occurred, typically around 1-2 weeks. *X-ray* - **Plain radiographs** are often the initial imaging study but are **insensitive** for early osteomyelitis, showing changes only after 10-14 days or more. - Early findings on X-rays can be subtle, such as **periosteal elevation** or **soft tissue swelling**, but frank bone destruction is a late finding. *Bone scintigraphy* - **Bone scintigraphy** (e.g., technetium-99m) is sensitive for detecting increased bone turnover associated with infection but lacks **specificity**, as it can be positive in other conditions like trauma or tumors. - While it can detect changes earlier than X-rays, typically within 2-3 days, it cannot clearly differentiate infection from other processes, and its spatial resolution is poor compared to MRI.
Question 3: 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 4: Myodesis is employed in amputations for all of the following indications except:
- A. Ischemia (Correct Answer)
- B. Tumor
- C. Children
- D. Trauma
Explanation: ***Ischemia*** - **Ischemia** is the primary exception where myodesis is often contraindicated or avoided - In ischemic limbs, compromised blood supply limits muscle viability and healing capacity - Poor vascularity prevents adequate muscle-to-bone integration and increases risk of wound complications - Simple myoplasty (muscle-to-muscle suturing) or guillotine-type procedures are often preferred in severe ischemia to ensure primary healing - The priority is achieving a viable stump rather than optimal functional reconstruction *Trauma* - Trauma is one of the **best indications** for myodesis when adequate healthy tissue is available - Creates a stable, functional residual limb with better proprioception for prosthetic fitting - Muscle-to-bone attachment provides superior control and reduces phantom limb pain - Standard technique in traumatic amputations with good soft tissue coverage *Tumor* - Myodesis can be performed in oncological amputations if surgical margins allow - While oncological clearance is the priority, functional reconstruction with myodesis is still pursued when feasible - Modern limb-sparing principles encourage maintaining function alongside adequate resection *Children* - Children are **excellent candidates** for myodesis - Promotes better skeletal growth and long-term functional adaptation - Maintains soft tissue bulk and provides stable base for prosthetic use as the child grows - Helps prevent muscle atrophy and improves quality of life
Question 5: 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 6: Patellar tendon-bearing P.O.P. cast is indicated in the following fracture:
- A. Fracture of the tibia (Correct Answer)
- B. Fracture of the patella
- C. Fracture of the femur
- D. Fracture of the medial malleolus
Explanation: ***Fracture of the tibia*** - A **patellar tendon-bearing (PTB) cast** is specifically designed to bypass the knee joint and transfer weight from the patellar tendon to the cast, offloading the tibia. - This design is particularly useful for **stable, distal tibia fractures** where partial weight-bearing is desired to promote healing. *Fracture of the patella* - A PTB cast would place direct pressure on the **patella**, which is contraindicated in a patellar fracture. - Patellar fractures often require a **cylinder cast** or surgical fixation to immobilize the knee. *Fracture of the femur* - Femoral fractures are typically **more proximal** and require **traction**, **internal fixation**, or a **spica cast** for stabilization. - A PTB cast would not provide adequate immobilization or weight-bearing relief for a femoral fracture due to its design. *Fracture of the medial malleolus* - Medial malleolus fractures involve the **ankle joint**, which is distal to the area covered by a PTB cast. - These fractures typically require a **short leg cast** or surgical repair, focusing on ankle stabilization.
Question 7: 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 8: Surgery was performed as shown in the image below. What is the name of the procedure?
- A. Below knee amputation
- B. Above knee amputation
- C. Lisfranc amputation
- D. Chopart amputation (Correct Answer)
Explanation: ***Chopart amputation*** - The image shows a disarticulation through the **talonavicular and calcaneocuboid joints**, which defines a **Chopart amputation**. - This procedure removes the distal foot while preserving the **calcaneus and talus**, forming a stump that allows for some ankle motion. *Below knee amputation* - A below-knee amputation involves transection of the tibia and fibula, preserving the knee joint, which is much more proximal than shown in the image. - This type of amputation removes a significant portion of the lower leg, with the foot entirely removed, unlike the partial foot amputation depicted. *Above knee amputation* - An above-knee amputation involves disarticulation or transection through the femur, completely removing the lower leg and knee joint. - This is a much more extensive amputation than what is illustrated, which is confined to the foot. *Lisfranc amputation* - A Lisfranc amputation is a disarticulation through the **tarsometatarsal joints**, removing the metatarsals and phalanges but preserving the tarsal bones. - The image clearly shows the incision more proximally, at the midtarsal level, specifically through the talonavicular and calcaneocuboid joints, not the tarsometatarsal joints.
Question 9: 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 10: 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.
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