Arthroplasty Practice Questions

Q: What is the primary indication for total hip replacement in osteoarthritis?

Failed conservative treatment. ***Failed conservative treatment*** - Total hip replacement (THR) is typically reserved for severe **osteoarthritis** where **non-surgical interventions** like pain medication, physical therapy, and lifestyle modifications no longer provide adequate pain relief or functional improvement. - This option reflects the standard clinical pathway in managing chronic joint degenerative conditions, emphasizing that surgery is a last resort after exhausting less invasive treatments. *Hip dysplasia* - While hip dysplasia can lead to osteoarthritis over time, it is a developmental condition, and its primary treatment in younger individuals might involve osteotomy to correct the abnormal hip structure, rather than immediate THR. - THR is used for hip dysplasia only if it has progressed to severe osteoarthritis and conservative management has failed. *Intertrochanteric fractures* - **Intertrochanteric fractures** of the femur are typically treated with internal fixation (e.g., intramedullary nail or dynamic hip screw) or hemiarthroplasty, depending on the fracture pattern and patient's age and co-morbidities. - Total hip replacement may be considered in a select group of patients with severe comminution involving the femoral head or pre-existing severe osteoarthritis, but it is not the primary indication for these fractures. *Unstable pelvic fractures* - **Unstable pelvic fractures** are acute traumatic injuries that require urgent surgical stabilization, often with external fixation or open reduction and internal fixation. - These fractures are not managed with total hip replacement, which is an elective procedure for chronic degenerative joint disease.

Q: Which surgical technique is indicated for a 60-year-old patient with severe arthritis and imaging that shows extensive hip joint damage?

Total hip replacement. ***Total hip replacement*** - For **severe arthritis** and extensive hip joint damage in a 60-year-old, total hip replacement is the most definitive surgical solution to **relieve pain** and restore function. - This procedure involves removing damaged bone and cartilage and replacing them with **prosthetic components**. *Arthroscopic debridement* - This is a minimally invasive procedure, but it is typically reserved for **mild to moderate arthritis** or to address specific mechanical problems like loose bodies, not extensive damage. - It does not address widespread cartilage loss or significant joint degeneration. *Osteotomy* - An osteotomy involves surgically **realigning bones** to shift weight from damaged areas to healthier cartilage. - It's generally considered for younger patients with **early-stage arthritis** or specific deformities, not typically for severe, extensive damage in an older patient. *Steroid joint injection* - Steroid injections are **palliative treatments** aimed at reducing inflammation and pain. - They provide **temporary relief** and do not repair or replace damaged joint structures, making them unsuitable for extensive damage requiring surgical intervention.

Q: A 30-year-old patient presents with right hip pain. An X-ray shows an avascular femoral head. What is the best treatment option for this condition if the patient has a collapsed femoral head with acetabular involvement?

Total hip replacement. ***Total hip replacement*** - A **collapsed femoral head** with **acetabular involvement** indicates advanced avascular necrosis, making reconstructive options like total hip replacement the most effective treatment. - This procedure alleviates pain and restores function by replacing the damaged joint surfaces with prosthetic components, which is crucial for patients with significant structural damage and symptoms. *Core decompression* - This procedure is primarily considered for **early stages** of avascular necrosis, before significant collapse of the femoral head. - It aims to reduce intraosseous pressure and promote revascularization, but it is less effective once the femoral head has already collapsed and the acetabulum is involved. *Bone marrow transplantation* - Bone marrow transplantation (specifically **autologous concentrated bone marrow aspirate**) can be used as an adjuvant therapy in earlier stages of avascular necrosis to promote healing, but it is not a primary treatment for a collapsed femoral head with acetabular involvement. - This option does not address the structural failure of the joint that has already occurred. *Non-weight bearing exercises* - While **non-weight-bearing** is often advised in early avascular necrosis to reduce stress on the hip, it is a conservative measure and will not reverse the damage of a collapsed femoral head or resolve acetabular involvement. - This approach mainly focuses on preventing further progression rather than treating established severe damage.

Question 1

What is the primary indication for total hip replacement in osteoarthritis?

Accepted Answer

Failed conservative treatment

Answer

Hip dysplasia

Answer

Intertrochanteric fractures

Answer

Unstable pelvic fractures

Question 2

Which surgical technique is indicated for a 60-year-old patient with severe arthritis and imaging that shows extensive hip joint damage?

Accepted Answer

Total hip replacement

Answer

Arthroscopic debridement

Answer

Osteotomy

Answer

Steroid joint injection

Question 3

A 30-year-old patient presents with right hip pain. An X-ray shows an avascular femoral head. What is the best treatment option for this condition if the patient has a collapsed femoral head with acetabular involvement?

Accepted Answer

Total hip replacement

Answer

Core decompression

Answer

Bone marrow transplantation

Answer

Non-weight bearing exercises

Question 4

A 68-year-old female with a history of osteoporosis presents with a hip fracture and is scheduled for hemiarthroplasty. What intraoperative strategies are critical to minimizing the risk of complications?

Accepted Answer

Choice of cemented vs. uncemented prosthesis, blood loss management, and perioperative antibiotic prophylaxis

Answer

Speed of the surgery

Answer

Patient’s dietary habits

Answer

Use of the least expensive prosthesis

Arthroplasty — MCQs

Arthroplasty — MCQs

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