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A 38-year-old female patient presents to your office three years after a hip resurfacing. She complains of worsening left hip discomfort for the last 6 months. Her ESR is 12 (normal 0-20) and CRP is 1.2 (0-5). A radiograph and axial and coronal MRI scans are shown in Figures A, B, and C. What is the most likely diagnosis?
Type I Hypersensitivity reaction
Femoral neck fracture
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Figure A shows a radiograph of a 62-year-old female that underwent a left total hip arthroplasty 5 years ago. She presents to your office with insidious onset of left groin and buttock pain. She denies trauma, fever or chills. On physical examination, her left hip has mild pain with range of motion. She has a normal gait cycle, normal power across the hip and her vitals signs are stable. A left hip aspirate was performed and results are shown in Figure B. What is the most likely cause of her hip pain?
Periprosthetic bacterial hip infection
Periprosthetic hip fracture
Large-particle wear debris disease
Pseudotumor hypersensitivity response
Abductor tendon tear
A 55-year-old patient returns for followup 2 years after a left ceramic-on-ceramic total hip arthroplasty. He has no pain or symptoms of instability. The video in Figure V shows him ascending stairs. All of the following factors may contribute to this phenomenon EXCEPT
Loss of fluid film lubrication.
A 67-year-old female complains of anterior groin pain one year following a primary, uncemented total hip arthroplasty. The pain is exacerbated when she tries to climb stairs or get up from a seated position. She denies any recent fevers or chills. On physical exam, the pain is reproduced with resisted seated hip flexion. Laboratory analysis, including WBC, ESR, and CRP are within normal limits. Radiographs reveal that the components are appropriately positioned without evidence of loosening or fracture. Which of the following is the most appropriate at this time?
Revision of the acetabular component
Image-guided diagnostic injection of lidocaine into the iliopsoas tendon sheath
Conservative management including activity modifications, NSAIDs, and physical therapy
A 45-year-old man has had the gait disturbance shown in Video A ever since a total hip replacement two years ago. Since then he has undergone physical therapy and nerve exploration without any clinical improvement. Extensive AFO bracing was attempted but was not tolerated by the patient. A recent ankle radiograph is shown in Figure A. The Silfverskiold test reveals dorsiflexion of 20 degrees with knee flexion, and 10 degrees with full knee extension. The results of muscle testing using a Cybex dynamometer are shown in Figure B. What is the most appropriate next step in in treatment.
Ankle arthrodesis in 30 degrees of dorsiflexion
Posterior tibial tendon transfer to the lateral cuneiform through the interosseous membrane
Split anterior tibial tendon transfer to the cuboid
Peroneus longus transfer to the navicular and gastrocnemius recession
Flexor hallucis transfer to the navicular and tendo Achilles lengthening (TAL)
A 58-year-old patient who underwent bilateral hip arthroplasty 12 years ago now reports pain in his hips and difficulty with ambulation to the point where he now uses crutches. A radiograph of the hip and pelvis is shown in Figure 26. What is the best treatment option for this patient?
Revision hip arthroplasty with a bipolar implant
Revision hip arthroplasty with impaction grafting on the femoral and acetabular side
Revision hip arthroplasty with a cemented jumbo acetabular component
Revision hip arthroplasty with a cementless acetabular component
Acetabular component revision with a tri-flange protrusio ring
Figure 23 shows failure of the femoral stem in a patient. What is the most likely reason for the failure?
A 62-year-old patient is seen for routine follow-up after undergoing cementless total hip arthroplasty 2 years ago. The patient reports limited range of motion that severely affects daily activities. A radiograph is shown in Figure 51. Management should now consist of
nonsteroidal anti-inflammatory drugs and protected weight bearing.
irradiation to the affected area.
surgical excision and postoperative irradiation.
Figure 49 shows a histologic section of the lung in a patient who died during total hip arthroplasty. What unexpected finding is seen in the pulmonary capillaries?
A metal-on-metal bearing used for total hip arthroplasty shows which of the following properties?
Baseline serum ion levels increase with increasing activity levels.
The risk of cancer is substantially increased.
Linear ion production increases over time.
Ions produced are excreted primarily through the kidney.
Nickel is the most prevalent ion released into circulation.
The preoperative pelvic radiograph of a 63-year-old female with osteoarthritis is shown in Figure A. She undergoes an uncomplicated total hip replacement. Six weeks post-operatively she complains that her right leg is longer than her left, and an AP pelvic radiograph is obtained which is shown in Figure B. Physical exam shows normal post-operative range of motion and strength in both hips. What is the most likely etiology for this patients gait impairment?
Hip flexion contracture
Excessive medialization of the acetabular component
Patient's perceived leg length discrepancy
Hip adduction contracture
Malpositioning of the femoral component