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4.2 of 74 Ratings
A 75-year-old female wishes to proceed with total hip arthroplasty (THA) for osteoarthritis. Her past medical history is significant for hypertension, hypothyroidism, and lumbar degenerative disease. She underwent uncomplicated L5-S1 posterior lumbar fusion 5 years ago. If seen on pelvic radiographs when moving from standing to sitting, which of the following parameter changes would increase her risk for postoperative THA dislocation the most?
Decreased lumbar lordosis
Decreased pelvic tilt
Decreased sacral slope
Increased acetabular anteversion
Increased pelvic incidence
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A 56-year-old male undergoes a total hip arthroplasty (THA). Which of the following would increase the patient's risk for dislocation or instability?
Acetabular cup anteversion of 16 degrees
Acetabular cup abduction of 45 degrees
High femoral offset
Reduced femoral head to neck ratio
Figures A and B show pre- and post-operative radiographs of a sedentary 75-year-old female who underwent surgery on her left hip. Based on the radiographic findings, what was the most likely indication for revision surgery?
Left acetabular fracture
Left acetabular cup osteolysis
Left femoral stem osteolysis
Left hip instability
Left femoral stem valgus malalignment
A 73-year-old female undergoes a total hip arthroplasty (THA) using a cemented stem design shown in Figure A. She returns to clinic 3 years post-operatively with signifcant thigh pain. Current radiographs, shown in Figure B, demonstrate femoral subsidence. What affect does this have on the biomechanics of her THA?
Excursion distance is decreased
Primary arc range is increased
Abductor complex tension is decreased
Joint reactive forces are decreased
Femoral offset is increased
A 65-year-old male with chronic right hip pain undergoes the procedure seen in Figure A utilizing a posterior approach. Which of the following hip positions would put the patient at the greatest risk for dislocation?
Abduction and external rotation
Flexion and external rotation
Flexion and internal rotation
Extension and internal rotation
Extension and external rotation
A 68-year-old male 2 weeks status post left total hip arthroplasty experiences a painful clunk getting out of bed in the morning. He is unable to bear any weight on the left leg. A radiograph is provided in figure A. Following closed reduction under sedation, the hip continues to dislocate with flexion up to 90 degrees. Each of the following operative interventions will increase the stability of the hip EXCEPT:
Revising the acetabular component to a more medialized position
Advancing the trochanter distal on the femur
Converting to a femoral component with extended offset
Replacing the acetabular polyethylene with a constrained liner
Replacing the femoral head with a larger size
Which of the following situations is appropriate for revision of a total hip arthroplasty to a constrained acetabular liner?
Periprosthetic acetabular fracture with resulting pelvic discontinuity
Chronically infected total hip arthroplasty
Recurrent dislocations in a patient whose femoral component is positioned in 15° retroversion
Recurrent dislocations in a patient whose cup is positioned in 10° retroversion and 60° abduction
Recurrent dislocations in a patient whose cup is positioned in 20° anteversion and 40° abduction
All of the following are acceptable indications for use of a constrained acetabular component EXCEPT:
Recurrent dislocations due to abductor insufficiency
Recurrent dislocations due to unsalvageable capsular attenuation
Recurrent dislocations due to severe polyethylene wear
Recurrent late dislocations without component loosening or malposition
Recurrent dislocations due to cognitive or neuromuscular disease
A 60-year-old male had a total hip replacement 8 years ago. There is evidence of eccentric polyethylene wear and some retroacetbular osteolysis. You discuss treatment options of acetabular revision if the component is found to be loose intra-operatively versus isolated polyethylene exchange if the acetabular component is stable intra-operatively with the patient. What is the most common complication of isolated polyethylene exchange with bone grafting that should be disclosed?
Sciatic nerve injury
Intraoperative acetabular fracture
Postoperative hip instability
Catastrophic implant failure
A 70-year-old man underwent total hip arthroplasty 4 months ago and has experienced 3 dislocations. Radiographs reveal no failure of the hardware and an acetabular component that has an abduction angle of 40 degrees and a version of 10 degrees retroverted. What is the most appropriate treatment for the recurrent dislocations?
hip abduction brace
revision of the acetabular liner to a constrained type
revision of the entire acetabular component
revision of the femoral head to a larger size
revision to an extended offset prosthesis
What is the most common complication after revision of a total hip polyethylene liner in a patient with well-fixed femoral and acetabular shell components?
failure of the femoral component
failure of the fixation between the liner and the acetabular shell
fracture of the polyethylene
A 68-year-old woman who underwent a right total hip arthroplasty 1 year ago has dislocated her hip five times since surgery. Radiographs show a retroverted acetabular component. What is the best treatment for this patient?
Use a constrained acetabular liner
Revise the femoral component to provide greater femoral offset
Revise the femoral head from a 28-mm head size to a 36-mm head size
Revise the acetabular component to 15 degrees of anteversion and 45 degrees of abduction
Perform a greater trochanteric osteotomy to improve soft-tissue tension
Figure 27 shows the AP radiograph of a patient who has late instability. The problem most likely occurred as a result of
greater trochanter detachment.
femoral stem loosening.
A 59-year-old woman who underwent a total hip arthroplasty 5 years ago now has recurrent dislocation following bariatric surgery and a weight loss of 200 lb. An attempt at converting to a larger head size and trochanteric advancement has failed. Her components are well aligned. What is the best course of action?
Hip abduction brace
Constrained acetabular liner
Thermal ablation of the posterior capsule
Conversion to a bipolar prosthesis
At the time of the revision surgery shown in Figure 14, the acetabular component was found to be stable. Polyethylene exchange with a standard ultra-high molecular weight polyethylene liner and grafting was performed. The patient is at significantly increased risk for
loosening of the femoral component.
loosening of the acetabular component.
prosthetic hip dislocation.
rapid wear of the polyethylene.
continued expansion of the lytic defects.
A 64-year-old healthy female patient underwent right total hip replacement (THR) through a posterior approach 6 months ago. She has now dislocated posteriorly 3 times, each followed by closed reduction under anesthesia in the operating room. A radiograph is provided in Figure A. Treatment should include:
Hip spica casting
Revision of the femoral component to a modular stem with retention of the acetabular component
Revision of the acetabular component
Hip abduction bracing
Revision to a constrained liner with retention of the acetabular and femoral prostheses
A 62-year-old woman presents for her 1-year follow-up after a revision right total hip arthroplasty. She has no complaints of pain and has returned to all her activities of daily living. An AP radiograph is shown in Figure A. The black arrow in the radiograph indicates she is at higher risk for which of the following?
Aseptic lymphocytic vasculitis-associated lesions (ALVAL)
Third body wear
Catastrophic ceramic bearing failure