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Which of the following is the most common intraoperative complication in a patient with sickle cell disease undergoing a total hip arthroplasty?
Periprosthetic fracture distal to the implant
Iatrogenic fracture causing pelvic discontinuity
Perforation of the femoral canal
Cardiac arrest from fat embolization to lungs
Injury to the sciatic nerve
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A 45-year-old with a history of sickle cell anemia reports hip pain for the past 6 months. A radiograph of the affected hip is shown in Figure A. Which of the following interventions has been shown to have the best outcomes in this patient population?
Uncemented metal on polyethylene total hip arthroplasty
Cemented metal on polyethylene total hip arthroplasty
A 65-year-old patient was treated with an open reduction/internal fixation for a left femoral neck fracture sustained 25 years ago. Five years ago he developed hip pain and was converted to a left hip hemiarthroplasty. He presents with complaints of groin pain for the past 6 weeks. A recent radiograph is shown in Figure A. The patient’s physical exam is limited secondary to pain. Serum laboratory values are WBC-8.0, ESR-20, CRP-0.5. A synovial fluid aspirate of the hip demonstrates < 500 cells (60% PMN). What is the most likely cause of this patient's symptoms?
Infected hip hemiarthroplasty
Impingement of the hip hemiarthroplasty
A 47-year-old man presents with 1 week of left leg pain. 6 months prior he underwent a vascularized free-fibula bone graft from his left leg to his right hip for avascular necrosis. The pain is located at the level of his donor site and is worse with weight-bearing and relieved by rest. Physical exam shows focal tenderness over his tibia. A lateral radiograph from the day of presentation is shown in Figure A. WBC, ESR, and CRP are all within normal limits. What is the next best step in management to confirm the diagnosis?
Compartment pressure measurements
Ultrasound to rule out deep abscess
In patients with sickle cell disease and asymptomatic osteonecrosis of the femoral head identified with magnetic resonance imaging, what percentage will eventually go on to femoral head collapse?
11% to 25%
26 to 50%
51 to 75%
A 40-year-old man complains of increasing groin pain. Radiographs show femoral head avascular necrosis with subchondral lucency but without femoral head collapse. Which of the following medical treatments have been shown to decrease the risk of subsequent femoral head collapse?
Cyclic parathyroid hormone therapy
RANK ligand therapy
Selective estrogen receptor modulator therapy
Osteonecrosis of the large joints may develop in patients with which of the following conditions?
Collagen I disease
Antiphospholipid syndrome (APS)
A 30-year-old patient has had severe left hip pain and difficulty ambulating, necessitating the use of a cane, for the past 6 months. A photomicrograph of the femoral head sectioned at the time of surgery is shown in Figure 31. What is the most likely diagnosis?
Figure 30 shows the MRI scan of a 68-year-old woman who has left hip pain. What is the most appropriate treatment?
Open reduction and internal fixation
Total hip arthroplasty
Proximal femoral resection and reconstruction
A 41-year-old male has steroid-induced avascular necrosis of the hip and decides to undergo metal on polyethylene total hip arthroplasty. His 80-year-old, sedentary father had a total hip replacement 5 years ago. With comparison to his father, the patient should be informed of the following risk?
Increased risk of sciatic nerve palsy
Increased longevity of prothesis
Increased risk for polyethylene wear and osteolysis
Reduced range of motion
Lower likelihood of revision surgery