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Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.
A 66-year-old male is undergoing a total knee arthroplasty using a fixed bearing posterior stabilized component. During intraoperative trialing of the components it is noted that the flexion gap is loose, and extension gap is appropriate. If this is not corrected, what post-operative complication is this patient most at risk of having?
Spin out of the polyethylene
Posterior knee dislocation
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During trialing for a cruciate-sacrificing total knee arthroplasty, the surgeon notes an imbalance between the flexion and extension gaps with significant flexion instability. The extension gap is well balanced. Which of the following options is the best intra-operative solution?
Downsize the femoral component
Downsize the tibial component
Upsize the femoral component and add posterior augments
Upsize the tibial component
Move the femoral component more anteriorly
During a primary total knee arthroplasty, trial of components demonstrates a knee that is balanced in flexion and loose in extension. Which of the following will balance the flexion and extension gap?
Distal femur resection only
Distal femur augmentation and use of the same size polyethylene
Downsize femoral component and use a thinner polyethylene insert
Proximal tibia resection only
Distal femur augmentation and thicker polyethylene insert
When performing a total knee arthroplasty using intramedullary referencing, the knee is stable at full extension, but it will not flex past 90 degrees. Which of the following adjustments can achieve satisfactory range of motion and stability in flexion and extension?
Downsizing the tibial insert
Placing posterior femoral augments
Resecting more distal femur
Downsizing the femoral component
Performing a medial tibial reduction osteotomy
During trialing for a cruciate-retaining total knee arthroplasty, the surgeon is unable to fully extend the knee and is left with a 15 degree flexion contracture. The flexion gap is well balanced. Which of the following options will create a knee that is balanced in both flexion and extension?
Recess the PCL
Increase the tibial slope
Decrease the size of the femoral component
Resect more distal femur
Resect more proximal tibia
While performing a revision total knee arthroplasty, the surgeon decides to upsize the femoral component with use of posterior femoral augments. Which of the following intraoperative exam findings would have led to this decision?
A knee that is balanced in extension and tight in flexion.
A knee that is balanced in extension and loose in flexion.
A knee that is tight in extension and tight in flexion.
A knee that is loose in extension and loose in flexion.
A knee that is loose in extension and balanced in flexion.
After insertion of the trial components in a total knee replacement, the surgeon finds that he is unable to fully extend the knee and that the tibial tray lifts-off when the knee is flexed past 90 degrees. What intervention should be taken to achieve a knee that is balanced in flexion and extension?
Augment the distal femur
Resect more distal femur
Increase polyethylene liner thickness
A patient comes to the office with a flexion contracture following a total knee arthroplasty that has resulted in an unsatisfactory outcome. Intraoperative examination also reveals the knee is loose in flexion. What steps should be included in the revision surgery?
Increase the polyethylene liner thickness
Resect additional tibia
Anteriorly translate the femoral component and decrease polyethylene thickness
Resect additional distal femur and tibia
Resect additional distal femur and upsize the femoral component
While trialing components during a routine total knee arthroplasty, the flexion gap is felt to be loose and the extension gap is stable. Which of the following are possible ways to treat this intraoperative instability?
Move the femoral component posterior
Increase the size of the polyethylene component
Downsize the femoral component
Move the femoral component anterior and augment the distal femur
Externally rotate both the femoral component and tibial components
A 62-year-old woman is undergoing a revision total knee arthroplasty for aseptic component loosening. The surgeon has all the trial components in place and recognizes that the soft tissues are balanced in the coronal plane, but the knee is 10 degrees from reaching full extension. He proceeds to correct the contracture by making an additional 2mm cut off of the tibia and is successful in achieving full extension. What is the most likely effect of this additional resection?
Loss of full flexion
A 62-year-old man undergoes total knee arthroplasty. Preoperative radiographs are shown in Figure A. Following bone resections and placement of trial implants, the knee is stable in flexion, but cannot achieve full extension. Which of the following interventions will most likely result in a knee that is balanced in flexion and extension?
Resect more distal femur and downsize the femoral component
Decrease polyethelene liner thickness
Place posterior femoral augments
During total knee replacement with the trial components in place, the knee achieves full extension but experiences tightness in flexion with a range to only 90 degrees. What is the most appropriate action?
Addition of a distal femoral augment
Downsize the tibial polyethylene insert
During total knee arthroplasty, an excessive posterior femoral resection will lead to which of the following scenarios?
Loose extension and flexion gaps
Loose extension gap
Loose flexion gap
Tight flexion gap
Tight extension gap
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