4.4 of 93 Ratings
Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 67-year-old woman with poliomyelitis presents with quadriceps weakness and chronic right knee pain for the last 2 years. She is scheduled to undergo right total knee arthroplasty (TKA) after failing nonoperative modalities. Her preoperative radiographs are shown in Figures A and B. What technique should be utilized to optimize her function and to prevent the recurrence of her deformity?
Posterior stabilized design with under-resection of distal femur
Posterior stabilized design with under-resection of proximal tibia
Posterior stabilized design with under-resection of posterior femur
Varus-valgus constrained design
Rotating hinge design
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Resection of the posterior cruciate ligament during total knee arthroplasty simulates which of the following techniques below?
Excessive distal femur resection
Excessive distal femur augmentation
Excessive posterior femur resection
Excessive posterior femur augmentation
Oversized femoral component
An ambulatory 57-year-old man with post-polio syndrome presents for follow-up of his right knee pain. He has failed all nonoperative measures for his right knee pain. On exam, he hyperextends to 15° and flexes to 120° with global instability of the knee. He has maintained antigravity strength in the right limb. Radiographs are shown in Figures A and B. What is the best treatment option for this patient?
Cruciate retaining knee with ligamentous reconstruction
Robotic-assisted posterior stabilized total knee arthroplasty
Distal femoral osteotomy with total knee arthroplasty
Hinged total knee arthroplasty
Which of the following is an absolute indication for constrained nonhinged total knee arthroplasty (TKA)?
Conversion TKA from knee arthrodesis
Repairable intra-operative MCL injury
Revision of medial unicondylar knee arthroplasty (UKA) to TKA for aseptic loosening
Varus deformity >20 degrees with LCL incompetency
When performing a cruciate-retaining (CR) total knee arthroplasty (TKA), all of the following are steps taken to recreate anatomic tension of the posterior cruciate ligament (PCL) EXCEPT:
Matching the anteroposterior dimension of the femoral component to the native femur
Ensuring full extension can be obtained through soft tissue release alone following only the most conservative distal femoral resection
Establishing anatomic tibial and femoral component rotation
Increasing the native posterior tibial slope to improve flexion and accommodate the prosthesis
Resecting as much tibia from the less affected side as will be replaced by the tibial component
Which of the following types of prosthetic designs, seen in figures A-E, has been shown to have a high rate of loosening secondary to overconstraint?
A patient undergoes the procedure depicted in Figures A and B with standard components (non-gender specific). Which of the following outcomes most appropriately describes the difference in females compared to males for this procedure?
Greater implant survivorship
Decreased WOMAC scores
Increased rate of extensor mechanism rupture
Increased postoperative pain
Increased component osteoloysis
A posterior cruciate retaining total knee arthroplasty is contraindicated in all of the following patients EXCEPT?
52-year-old female with severe rheumatoid arthritis of the knee
73-year-old male with post-traumatic arthritis of the knee and prior patellectomy
67-year-old male with degenerative arthritis and 10 degree valgus deformity of the knee
55-year-old male with post-traumatic arthritis of the knee 20 years after bicruciate ligament ruptures
63-year-old female with a chronic history of steroid treatment of systemic lupus erythematosus and an arthritic knee
In total knee arthroplasty, what would be a difference with use of the tibial component shown in Figure A compared to Figure B?
Increased ductility of the polyethylene
Increased wear on the articular side of the polyethylene
Less wear on the articular side of the polyethylene
More wear at the backside of the polyethylene
Less wear at the backside of the polyethylene
A patient with a documented allergy to nickel requires a total knee arthroplasty. Which of the following prostheses is most likely to provide long-term success in this individual?
All-polyethylene tibial component and pure titanium femoral component
All-polyethylene tibial component and cobalt-chromium alloy femoral component
Cobalt-chromium alloy tibial component and cobalt-chromium alloy femoral component
Modular titanium tibial component and pure titanium femoral component
Modular titanium tibial component and oxidized zirconium femoral component
When comparing mobile-bearing total knee arthroplasty (TKA) to fixed-bearing total condylar arthroplasty, the mobile-bearing procedure provides
no improvement in survivorship.
approximately 15 degrees greater flexion.
appreciable reduction in wear rates.
a faster recovery profile.
better quadriceps strength.
When performing knee arthroplasty, which of the following procedures provides the most consistent fixation for the tibial component?
Cementless fixation of the tibial component
Augmenting cementless fixation of the tibial component with pegs or screws
Cementing the metaphyseal portion and press fitting the keel of the tibial component
Cementing the metaphyseal and keel portions of the tibial component
Cemented fixation of the tibial component with screws
Increasing articular conformity of the tibial polyethylene insert of a fixed-bearing total knee arthroplasty (TKA) prosthesis will have which of the following biomechanical effects?
Decreased contact stress within the polyethylene
Decreased risk of patellofemoral instability
Decreased risk of mechanical loosening
Increased risk of subsurface polyethylene cracking
Increased femoral rollback during flexion
Figure A displays the preoperative radiographs of a 67-year-old obese, diabetic woman undergoing total knee arthroplasty. Following the bone resections, a PCL-substituting trial implant is placed. At full extension, 30 degrees of flexion, and 90 degrees of flexion, the knee is found to be tight laterally and loose medially. Sequential releases are made until the IT band, popliteus, and LCL have all been released, and a larger polyethylene trial is placed, but the knee continues to demonstrate medial laxity and lateral tightness. Which of the following should be done to achieve a successful outcome?
Surgical release of the lateral retinaculum
Surgical release of the lateral retinaculum and reconstruction of the medial patellofemoral ligament
Imbrication of the MCL and augmentation with allograft
Convert to a constrained TKA design
Recut the tibia in valgus to improve balance
A 57-year-old man complains of knee pain that is exacerbated with weight bearing and ambulation. He underwent surgery on his knee 10 years ago following a motor vehicle collision. On physical exam he has medial and lateral joint line tenderness and no instability. Radiographs are provided in figures A and B. Conservative therapy with NSAID's and viscosupplementation is initiated. If he continues to develop further degenerative changes and needs arthroplasty what type of implant should be utilized?
Unicompartmental mobile bearing knee arthroplasty
Posterior cruciate retaining total knee arthroplasty
Posterior stabilized total knee arthroplasty
Constrained nonhinged total knee arthroplasty
Constrained hinged total knee arthroplasty
The medial and lateral joint surfaces have different tibiofemoral geometry. How does this affect the kinematics of normal knee movement from full extension into flexion?
Tibia will externally rotate
Distal femur will pivot about a medial axis of the knee
Distal femur will translate anteriorly on the tibia
Distal femur will pivot about a lateral axis of the knee
A 55-year-old female with a long history of diabetes mellitus presents for evaluation of chronic knee pain. A current radiograph is shown in Figure A. Which of the following knee prostheses, shown in Figures B through E, would be most appropriate in the initial treatment of this patient?
Figure A demonstrates a total knee prosthesis design. Which of the following motions is constrained in this particular design:
Complete anterior-posterior translation constraint only
Partial varus-valgus angulation constraint only
Partial varus-valgus angulation and partial internal-external rotation constraint
Complete internal-external rotation constraint only
Complete varus-valgus angulation and anterior-posterior translation constraint
A 45-year-old woman is scheduled to undergo a TKA. Which of the following implant designs theoretically reduces poylethylene wear and reduces bone-implant-interface stress?
Posterior stabilized fixed bearing TKA
Cruciate retaining fixed bearing TKA
Mobile-bearing hinged TKA