Adult Reconstructive Surgery of the Hip and Knee Scored and
Recorded Self-Assessment Examination 2025/2026
, Question XX1
XX
What XXfactor XXis XXassociated XXwith XXa XXhigher XXrisk XXof XXdislocation XXafter XXtotal XXhip XXarthroplasty?
A. Male gender
B. Previous hip surgery
C. A direct lateral surgical approach
D. Metal-on-metal bearing surfaces
CORRECT XXANSWER XX: XXB
XXDISCUSSION:
Dislocation XXafter XXtotal XXhip XXarthroplasty XXis XXa XXmultifactorial XXproblem. XXNumerous XXrisk XXfactors
XXmay XXact XXindependently XXor XXcumulatively XXto XXincrease XXthe XXrisk XXof XXthis XXcomplication.
XXPrevious XXhip XXsurgery XXof XXany XXkind XXis XXassociated XXwith XXa XXtwofold XXincreased XXrisk XXfor
XXdislocation. XXOther XXrisk XXfactors XXinclude XXfemale XXgender, XXimpaired XXmental XXstatus,
XXinflammatory XXarthritis, XXand XXolder XXage. XXNumerous XXstudies XXhave XXshown XXa XXlower
XXdislocation XXrate XXwith XXa XXdirect XXlateral XXapproach, XXalthough XXsurgical XXtechniques XXsuch XXas
XXcapsular XXrepair XXhave XXsignificantly XXlowered XXthe XXincidence XXof XXdislocation XXafter XXusing XXthe
XXposterior XXapproach. XXMetal-on-metal XXbearings XXhave XXbeen XXassociated XXwith XXother XXcomplications
XXsuch XXas XXadverse XXtissue XXreactions XXbut XXare XXoften XXused XXwith XXlarger-diameter XXbearings, XXwhich
XXpose XXa XXlower XXrisk XXof XXdislocation.
XX Question XX2
XXA XXpatient XXhas XXpain XX2 XXyears XXafter XXundergoing XXa XXmetal-on-metal XX(MOM) XXleft XXtotal XXhip
XXarthroplasty XX(THA). XXWhich XXtest(s) XXbest XXcorrelate XXwith XXa XXprognosis XXif XXthis XXpatient XXis XXhaving
XXa XXreaction XXto XXmetal XXdebris?
A. Erythrocyte sedimentation rate, C-reactive protein, and white blood cell count
B. Serum cobalt and chromium ion levels
C. MRI with metal artifact reduction sequence (MARS)
D. CT of pelvis
CORRECT XXANSWER: XXC
XXDISCUSSION:
Painful XXMOM XXTHA XXand XXtaper XXcorrosion XXcan XXcause XXsubstantial XXdamage XXto XXa XXpatient's
XXhip XXif XXleft XXuntreated. XXIn XXthis XXcase, XXthe XXworkup XXfor XXa XXpainful XXMOM XXTHA XXstarts XXthe
XXsame XXas XXa XXworkup XXfor XXa XXpainful XXmetal-on- XXpolyethylene XXbearing XXcouple. XXInfection XXmust
XXbe XXruled XXout XXin XXevery XXcase XXwith XXa XXset XXof XXinflammatory XXmarkers. XXIf XXthese XXmarkers XXare
XXremotely XXelevated, XXthis XXis XXan XXindication XXfor XXjoint XXaspiration. XXIn XXpatients XXwith XXmetal
XXdebris, XXthe XXpathology XXreport XXoften XXindicates XXtoo XXmany XXcells XXto XXcount XXor XXcellular XXdebris.
XXMetal XXion XXlevels XXdo XXnot XXseem XXto XXcorrelate XXwith XXprognosis. XXThere XXare XXwell-functioning
XXpatients XXwith XXhigh XXion XXlevels XXand XXpoor- XXfunctioning XXpatients XXwith XXlow XXion XXlevels.
XXAdvanced XXimaging XXwith XXMARS XXMRI XXto XXevaluate XXfor XXperitrochanteric XXfluid XXcollection, XXa
XXsoft-tissue XXmass, XXor XXsynovial/capsular XXhypertrophy XXwill XXreveal XXsigns XXof XXa XXmetal XXreaction
XXthat XXindicate XXthe XXneed XXfor XXa XXrevision XXdiscussion. XXA XXCT XXscan XXcan XXshow XXmore XXadvanced
XXbony XXdestruction XXas XXan XXindicator XXof XXpoor XXprognosis. XXThese XXfilms XXcan XXbe XXused XXto XXdetermine
XXthe XXneed XXfor XXa XXstructural XXgraft XXor XXaugments XXfor XXreconstruction XXof XXbone XXloss XXattributable
XXto XXmetal XXdebris.
XX Question XX3
XXFigures XXbelow XXdemonstrate XXthe XXradiographs XXobtained XXfrom XXa XX35-year-old XXwoman XXwith
XXend-stage XXdebilitating XXosteoarthritis XXof XXthe XXright XXhip. XXShe XXis XXcontemplating XXtotal XXhip
XXarthroplasty XX(THA). XXShe XXhas XXa XXhistory XXof XXright XXhip XXdysplasia XXand XXunderwent XXhip
XXosteotomy XXas XXan XXadolescent. XXOver XXthe XXyears, XXnonsurgical XXtreatment, XXincluding XXweight
,XXloss, XXactivity XXmodifications, XXand XXintra-articular XXinjections, XXhas XXfailed. XXHer XXinfection XXwork-
up XXreveals XXlaboratory XXfindings XXwithin XXdefined XXlimits. XXA XXfurther XXwork-up XXreveals XXelevations
XXin XXserum XXcobalt XXand XXchromium XXlevels XXand XXfluid XXcollections XXsurrounding XXthe XXhip XXon
XXMRI XXwith XXMARS. XXRevision XXTHA XXis XXrecommended. XXThe XXmost XXcommon XXcomplication
XXfollowing XXrevision XXof XXa XXfailed XXmetal-on- XXmetal XXhip XXarthroplasty XXis
, A. infection.
B. instability.
C. loosening.
D. periprosthetic fracture.
CORRECT XXANSWER: XXB
XXDISCUSSION:
THA XXhas XXproven XXdurable XXand XXreliable XXfor XXpain XXrelief XXand XXimproving XXfunction XXfor
XXpatients XXwith XXend-stage XXarthritis. XXAppropriate XXbearing XXselection XXis XXcritical XXto XXminimize
XXwear XXand XXhip XXcomplications. XXA XXmetal-on- XXmetal XXarticulation XXis XXassociated XXwith XXexcellent
XXwear XXrates XXin XXvitro. XXWith XXits XXcapacity XXto XXoffer XXa XXlow XXwear XXrate XXwith XXlarge XXfemoral
XXheads, XXit XXis XXan XXattractive XXbearing XXchoice XXfor XXTHA. XXHowever, XXlocal XXsoft-tissue XXreactions,
XXpseudotumors, XXand XXpotential XXsystemic XXreactions XXincluding XXrenal XXfailure, XXcardiomyopathy,
XXcarcinogenesis, XXand XXpotential XXteratogenesis XXwith XXpotential XXtransfer XXof XXmetal XXions XXacross XXthe
XXplacental XXbarrier XXmake XXmetal-on-metal XXbearings XXless XXdesirable XXand XXrelatively
XXcontraindicated XXfor XXyounger XXwomen XXof XXchild- XXbearing XXage. XXThe XXworkup XXof XXa XXpainful
XXmetal-on-metal XXhip XXarthroplasty XXnecessitates XXa XXsystematic XXapproach. XXSeveral XXalgorithms
XXhave XXbeen XXproposed. XXRoutine XXlaboratory XXstudies XXincluding XXsedimentation XXrate, XXCRP, XXand
XXserum XXcobalt XXand XXchromium XXion XXlevels XXshould XXbe XXobtained XXfor XXall XXpatients XXwith XXpain.
XXAdvanced XXimaging XXincluding XXMARS XXMRI XXshould XXbe XXperformed XXto XXevaluate XXfor XXthe
XXpresence XXof XXfluid XXcollections, XXpseudotumors, XXand XXabductor XXmechanism XXdestruction. XXInfection
XXcan XXcoexist XXwith XXmetal-on-metal XXreactions, XXso, XXwhen XXindicated XX(if XXthe XXCRP XXlevel XXis
XXelevated), XXa XXhip XXarthrocentesis XXshould XXbe XXobtained. XXHowever, XXin XXthis XXsetting, XXa XXmanual
XXcell XXcount XXand XXdifferential XXshould XXbe XXobtained XXbecause XXan XXautomated XXcell XXcounter XXmay
XXprovide XXfalsely XXelevated XXcellcounts. XXThe XXresults XXof XXrevision XXsurgery XXfor XXa XXfailed XXmetal-
on-metal XXhip XXprosthesis XXcan XXbe XXvariable. XXThe XXamount XXof XXlocal XXtissue XXdestruction XXand
XXthe XXintegrity XXof XXthe XXhip XXabductor XXmechanism XXcan XXgreatly XXinfluence XXoutcomes. XXInstability
XXis XXthe XXmost XXcommon XXcomplication XXfollowing XXrevision XXof XXfailed XXmetal-on-metal XXhip
XXreplacements.
Question XX4
XX
XXFigure XX1 XXshows XXthe XXradiograph XXand XXFigure XX2 XXshows XXthe XXMRI XXscan XXobtained XXfrom XXa XX37-
year-old XXwoman XXwith XXa XX2-month XXhistory XXof XXleft XXhip XXpain. XXWhich XXcombination XXof XXa XXsingle
XXsymptom XXand XXexamination XXfinding XXis XXmost XXlikely XXin XXthis XXscenario?
Recorded Self-Assessment Examination 2025/2026
, Question XX1
XX
What XXfactor XXis XXassociated XXwith XXa XXhigher XXrisk XXof XXdislocation XXafter XXtotal XXhip XXarthroplasty?
A. Male gender
B. Previous hip surgery
C. A direct lateral surgical approach
D. Metal-on-metal bearing surfaces
CORRECT XXANSWER XX: XXB
XXDISCUSSION:
Dislocation XXafter XXtotal XXhip XXarthroplasty XXis XXa XXmultifactorial XXproblem. XXNumerous XXrisk XXfactors
XXmay XXact XXindependently XXor XXcumulatively XXto XXincrease XXthe XXrisk XXof XXthis XXcomplication.
XXPrevious XXhip XXsurgery XXof XXany XXkind XXis XXassociated XXwith XXa XXtwofold XXincreased XXrisk XXfor
XXdislocation. XXOther XXrisk XXfactors XXinclude XXfemale XXgender, XXimpaired XXmental XXstatus,
XXinflammatory XXarthritis, XXand XXolder XXage. XXNumerous XXstudies XXhave XXshown XXa XXlower
XXdislocation XXrate XXwith XXa XXdirect XXlateral XXapproach, XXalthough XXsurgical XXtechniques XXsuch XXas
XXcapsular XXrepair XXhave XXsignificantly XXlowered XXthe XXincidence XXof XXdislocation XXafter XXusing XXthe
XXposterior XXapproach. XXMetal-on-metal XXbearings XXhave XXbeen XXassociated XXwith XXother XXcomplications
XXsuch XXas XXadverse XXtissue XXreactions XXbut XXare XXoften XXused XXwith XXlarger-diameter XXbearings, XXwhich
XXpose XXa XXlower XXrisk XXof XXdislocation.
XX Question XX2
XXA XXpatient XXhas XXpain XX2 XXyears XXafter XXundergoing XXa XXmetal-on-metal XX(MOM) XXleft XXtotal XXhip
XXarthroplasty XX(THA). XXWhich XXtest(s) XXbest XXcorrelate XXwith XXa XXprognosis XXif XXthis XXpatient XXis XXhaving
XXa XXreaction XXto XXmetal XXdebris?
A. Erythrocyte sedimentation rate, C-reactive protein, and white blood cell count
B. Serum cobalt and chromium ion levels
C. MRI with metal artifact reduction sequence (MARS)
D. CT of pelvis
CORRECT XXANSWER: XXC
XXDISCUSSION:
Painful XXMOM XXTHA XXand XXtaper XXcorrosion XXcan XXcause XXsubstantial XXdamage XXto XXa XXpatient's
XXhip XXif XXleft XXuntreated. XXIn XXthis XXcase, XXthe XXworkup XXfor XXa XXpainful XXMOM XXTHA XXstarts XXthe
XXsame XXas XXa XXworkup XXfor XXa XXpainful XXmetal-on- XXpolyethylene XXbearing XXcouple. XXInfection XXmust
XXbe XXruled XXout XXin XXevery XXcase XXwith XXa XXset XXof XXinflammatory XXmarkers. XXIf XXthese XXmarkers XXare
XXremotely XXelevated, XXthis XXis XXan XXindication XXfor XXjoint XXaspiration. XXIn XXpatients XXwith XXmetal
XXdebris, XXthe XXpathology XXreport XXoften XXindicates XXtoo XXmany XXcells XXto XXcount XXor XXcellular XXdebris.
XXMetal XXion XXlevels XXdo XXnot XXseem XXto XXcorrelate XXwith XXprognosis. XXThere XXare XXwell-functioning
XXpatients XXwith XXhigh XXion XXlevels XXand XXpoor- XXfunctioning XXpatients XXwith XXlow XXion XXlevels.
XXAdvanced XXimaging XXwith XXMARS XXMRI XXto XXevaluate XXfor XXperitrochanteric XXfluid XXcollection, XXa
XXsoft-tissue XXmass, XXor XXsynovial/capsular XXhypertrophy XXwill XXreveal XXsigns XXof XXa XXmetal XXreaction
XXthat XXindicate XXthe XXneed XXfor XXa XXrevision XXdiscussion. XXA XXCT XXscan XXcan XXshow XXmore XXadvanced
XXbony XXdestruction XXas XXan XXindicator XXof XXpoor XXprognosis. XXThese XXfilms XXcan XXbe XXused XXto XXdetermine
XXthe XXneed XXfor XXa XXstructural XXgraft XXor XXaugments XXfor XXreconstruction XXof XXbone XXloss XXattributable
XXto XXmetal XXdebris.
XX Question XX3
XXFigures XXbelow XXdemonstrate XXthe XXradiographs XXobtained XXfrom XXa XX35-year-old XXwoman XXwith
XXend-stage XXdebilitating XXosteoarthritis XXof XXthe XXright XXhip. XXShe XXis XXcontemplating XXtotal XXhip
XXarthroplasty XX(THA). XXShe XXhas XXa XXhistory XXof XXright XXhip XXdysplasia XXand XXunderwent XXhip
XXosteotomy XXas XXan XXadolescent. XXOver XXthe XXyears, XXnonsurgical XXtreatment, XXincluding XXweight
,XXloss, XXactivity XXmodifications, XXand XXintra-articular XXinjections, XXhas XXfailed. XXHer XXinfection XXwork-
up XXreveals XXlaboratory XXfindings XXwithin XXdefined XXlimits. XXA XXfurther XXwork-up XXreveals XXelevations
XXin XXserum XXcobalt XXand XXchromium XXlevels XXand XXfluid XXcollections XXsurrounding XXthe XXhip XXon
XXMRI XXwith XXMARS. XXRevision XXTHA XXis XXrecommended. XXThe XXmost XXcommon XXcomplication
XXfollowing XXrevision XXof XXa XXfailed XXmetal-on- XXmetal XXhip XXarthroplasty XXis
, A. infection.
B. instability.
C. loosening.
D. periprosthetic fracture.
CORRECT XXANSWER: XXB
XXDISCUSSION:
THA XXhas XXproven XXdurable XXand XXreliable XXfor XXpain XXrelief XXand XXimproving XXfunction XXfor
XXpatients XXwith XXend-stage XXarthritis. XXAppropriate XXbearing XXselection XXis XXcritical XXto XXminimize
XXwear XXand XXhip XXcomplications. XXA XXmetal-on- XXmetal XXarticulation XXis XXassociated XXwith XXexcellent
XXwear XXrates XXin XXvitro. XXWith XXits XXcapacity XXto XXoffer XXa XXlow XXwear XXrate XXwith XXlarge XXfemoral
XXheads, XXit XXis XXan XXattractive XXbearing XXchoice XXfor XXTHA. XXHowever, XXlocal XXsoft-tissue XXreactions,
XXpseudotumors, XXand XXpotential XXsystemic XXreactions XXincluding XXrenal XXfailure, XXcardiomyopathy,
XXcarcinogenesis, XXand XXpotential XXteratogenesis XXwith XXpotential XXtransfer XXof XXmetal XXions XXacross XXthe
XXplacental XXbarrier XXmake XXmetal-on-metal XXbearings XXless XXdesirable XXand XXrelatively
XXcontraindicated XXfor XXyounger XXwomen XXof XXchild- XXbearing XXage. XXThe XXworkup XXof XXa XXpainful
XXmetal-on-metal XXhip XXarthroplasty XXnecessitates XXa XXsystematic XXapproach. XXSeveral XXalgorithms
XXhave XXbeen XXproposed. XXRoutine XXlaboratory XXstudies XXincluding XXsedimentation XXrate, XXCRP, XXand
XXserum XXcobalt XXand XXchromium XXion XXlevels XXshould XXbe XXobtained XXfor XXall XXpatients XXwith XXpain.
XXAdvanced XXimaging XXincluding XXMARS XXMRI XXshould XXbe XXperformed XXto XXevaluate XXfor XXthe
XXpresence XXof XXfluid XXcollections, XXpseudotumors, XXand XXabductor XXmechanism XXdestruction. XXInfection
XXcan XXcoexist XXwith XXmetal-on-metal XXreactions, XXso, XXwhen XXindicated XX(if XXthe XXCRP XXlevel XXis
XXelevated), XXa XXhip XXarthrocentesis XXshould XXbe XXobtained. XXHowever, XXin XXthis XXsetting, XXa XXmanual
XXcell XXcount XXand XXdifferential XXshould XXbe XXobtained XXbecause XXan XXautomated XXcell XXcounter XXmay
XXprovide XXfalsely XXelevated XXcellcounts. XXThe XXresults XXof XXrevision XXsurgery XXfor XXa XXfailed XXmetal-
on-metal XXhip XXprosthesis XXcan XXbe XXvariable. XXThe XXamount XXof XXlocal XXtissue XXdestruction XXand
XXthe XXintegrity XXof XXthe XXhip XXabductor XXmechanism XXcan XXgreatly XXinfluence XXoutcomes. XXInstability
XXis XXthe XXmost XXcommon XXcomplication XXfollowing XXrevision XXof XXfailed XXmetal-on-metal XXhip
XXreplacements.
Question XX4
XX
XXFigure XX1 XXshows XXthe XXradiograph XXand XXFigure XX2 XXshows XXthe XXMRI XXscan XXobtained XXfrom XXa XX37-
year-old XXwoman XXwith XXa XX2-month XXhistory XXof XXleft XXhip XXpain. XXWhich XXcombination XXof XXa XXsingle
XXsymptom XXand XXexamination XXfinding XXis XXmost XXlikely XXin XXthis XXscenario?
