Adult Reconstructive Surgery of the Hip and Knee SASE 2026 (PDF) | Self-Assessment Exam | AAHKS (Mayo Clinic Alix School of Medicine)

ADULT RECONSTRUCTIVE SURGERY OF THE HIP AND KNEE – AAOS – 2026–
COMPLETE SELF-ASSESSMENT EXAMINATION WITH SCORED PRACTICE
QUESTIONS AND ANSWER EXPLANATIONS




A+ ALREADY GRADED

, Questionkic1
kic

Whatkicfactorkiciskicassociatedkicwithkicakichigherkicriskkicofkicdislocationkicafterkictotalkichipkicarthroplasty?

A. Malekicgender
B. Previouskichipkicsurgery
C. Akicdirectkiclateralkicsurgicalkicapproach
D. Metal-on-metalkicbearingkicsurfaces
CORRECTkicANSWERkic:ki

cBkicDISCUSSION:

Dislocationkicafterkictotalkichipkicarthroplastykiciskicakicmultifactorialkicproblem.kicNumerouskicriskkicfactorskicmaykicac
tkicindependentlykicorkiccumulativelykictokicincreasekicthekicriskkicofkicthiskiccomplication.kicPreviouskichipkicsurgerykicofk
icanykickindkiciskicassociatedkicwithkicakictwofoldkicincreasedkicriskkicforkicdislocation.kicOtherkicriskkicfactorskicincludekicf


emalekicgender,kicimpairedkicmentalkicstatus,kicinflammatorykicarthritis,kicandkicolderkicage.kicNumerouskicstudieskicha
vekicshownkicakiclowerkicdislocationkicratekicwithkicakicdirectkiclateralkicapproach,kicalthoughkicsurgicalkictechniqueskicsu
chkicaskiccapsularkicrepairkichavekicsignificantlykicloweredkicthekicincidencekicofkicdislocationkicafterkicusingkicthekicpost
eriorkicapproach.kicMetal-on-
metalkicbearingskichavekicbeenkicassociatedkicwithkicotherkiccomplicationskicsuchkicaskicadversekictissuekicreactionskicbutkicar
ekicoftenkicusedkicwithkiclarger-diameterkicbearings,kicwhichkicposekicakiclowerkicriskkicofkicdislocation.
kic Questionkic2

Akicpatientkichaskicpainkic2kicyearskicafterkicundergoingkicakicmetal-on-
kic

metalkic(MOM)kicleftkictotalkichipkicarthroplastykic(THA).kicWhichkictest(s)kicbestkiccorrelatekicwithkicakicprognosiskicifkicthiskic
patientkiciskichavingkicakicreactionkictokicmetalkicdebris?
A. Erythrocytekicsedimentationkicrate,kicC-reactivekicprotein,kicandkicwhitekicbloodkiccellkiccount
B. Serumkiccobaltkicandkicchromiumkicionkiclevels
C. MRIkicwithkicmetalkicartifactkicreductionkicsequencekic(MARS)
D. CTkicofkicpelvis
CORRECTkicANSWER:kic

CkicDISCUSSION:

PainfulkicMOMkicTHAkicandkictaperkiccorrosionkiccankiccausekicsubstantialkicdamagekictokicakicpatient'skichipkicifkicleftkicu
ntreated.kicInkicthiskiccase,kicthekicworkupkicforkicakicpainfulkicMOMkicTHAkicstartskicthekicsamekicaskicakicworkupkicforkicakic
painfulkicmetal-on-
polyethylenekicbearingkiccouple.kicInfectionkicmustkicbekicruledkicoutkicinkiceverykiccasekicwithkicakicsetkicofkicinflammatorykicmar
kers.kicIfkicthesekicmarkerskicarekicremotelykicelevated,kicthiskiciskicankicindicationkicforkicjointkicaspiration.kicInkicpatientsk
icwithkicmetalkicdebris,kicthekicpathologykicreportkicoftenkicindicateskictookicmanykiccellskictokiccountkicorkiccellularkicdebris.


kicMetalkicionkiclevelskicdokicnotkicseemkictokiccorrelatekicwithkicprognosis.kicTherekicarekicwell-


functioningkicpatientskicwithkichighkicionkiclevelskicandkicpoor-
functioningkicpatientskicwithkiclowkicionkiclevels.kicAdvancedkicimagingkicwithkicMARSkicMRIkictokicevaluatekicforkicpe
ritrochanterickicfluidkiccollection,kicakicsoft-
tissuekicmass,kicorkicsynovial/capsularkichypertrophykicwillkicrevealkicsignskicofkicakicmetalkicreactionkicthatkicindicatekicth
ekicneedkicforkicakicrevisionkicdiscussion.kicAkicCTkicscankiccankicshowkicmorekicadvancedkicbonykicdestructionkicaskicankicindicat
orkicofkicpoorkicprognosis.kicThesekicfilmskiccankicbekicusedkictokicdeterminekicthekicneedkicforkicakicstructuralkicgraftkicorkicaugment
skicforkicreconstructionkicofkicbonekiclosskicattributablekictokicmetalkicdebris.
kic Questionkic3

Figureskicbelowkicdemonstratekicthekicradiographskicobtainedkicfromkicakic35-year-oldkicwomankicwithkicend-
kic

stagekicdebilitatingkicosteoarthritiskicofkicthekicrightkichip.kicShekiciskiccontemplatingkictotalkichipkicarthroplastykic(THA
).kicShekichaskicakichistorykicofkicrightkichipkicdysplasiakicandkicunderwentkichipkicosteotomykicaskicankicadolescent.kicOverkic

,thekicyears,kicnonsurgicalkictreatment,kicincludingkicweightkicloss,kicactivitykicmodifications,kicandkicintra-
articularkicinjections,kichaskicfailed.kicHerkicinfectionkicwork-
upkicrevealskiclaboratorykicfindingskicwithinkicdefinedkiclimits.kicAkicfurtherkicwork-
upkicrevealskicelevationskicinkicserumkiccobaltkicandkicchromiumkiclevelskicandkicfluidkiccollectionskicsurroundingkicthekic
hipkiconkicMRIkicwithkicMARS.kicRevisionkicTHAkiciskicrecommended.kicThekicmostkiccommonkiccomplicationkicfollow
ingkicrevisionkicofkicakicfailedkicmetal-on-metalkichipkicarthroplastykicis

, A. infection.
B. instability.
C. loosening.
D. periprosthetickicfracture.
CORRECTkicANSWER:kic

BkicDISCUSSION:

THAkichaskicprovenkicdurablekicandkicreliablekicforkicpainkicreliefkicandkicimprovingkicfunctionkicforkicpatientskicwithkicen
d-
stagekicarthritis.kicAppropriatekicbearingkicselectionkiciskiccriticalkictokicminimizekicwearkicandkichipkiccomplications.kic
Akicmetal-on-
metalkicarticulationkiciskicassociatedkicwithkicexcellentkicwearkicrateskicinkicvitro.kicWithkicitskiccapacitykictokicofferkicakiclo
wkicwearkicratekicwithkiclargekicfemoralkicheads,kicitkiciskicankicattractivekicbearingkicchoicekicforkicTHA.kicHowever,kicloca
lkicsoft-
tissuekicreactions,kicpseudotumors,kicandkicpotentialkicsystemickicreactionskicincludingkicrenalkicfailure,kiccardiomyo
pathy,kiccarcinogenesis,kicandkicpotentialkicteratogenesiskicwithkicpotentialkictransferkicofkicmetalkicionskicacrosskicthekicplace
ntalkicbarrierkicmakekicmetal-on-
metalkicbearingskiclesskicdesirablekicandkicrelativelykiccontraindicatedkicforkicyoungerkicwomenkicofkicchild-
bearingkicage.kicThekicworkupkicofkicakicpainfulkicmetal-on-
metalkichipkicarthroplastykicnecessitateskicakicsystematickicapproach.kicSeveralkicalgorithmskichavekicbeenkicproposed.ki
cRoutinekiclaboratorykicstudieskicincludingkicsedimentationkicrate,kicCRP,kicandkicserumkiccobaltkicandkicchromiumkici


onkiclevelskicshouldkicbekicobtainedkicforkicallkicpatientskicwithkicpain.kicAdvancedkicimagingkicincludingkicMARSkicMR
Ikicshouldkicbekicperformedkictokicevaluatekicforkicthekicpresencekicofkicfluidkiccollections,kicpseudotumors,kicandkicabduc
torkicmechanismkicdestruction.kicInfectionkiccankiccoexistkicwithkicmetal-on-
metalkicreactions,kicso,kicwhenkicindicatedkic(ifkicthekicCRPkiclevelkiciskicelevated),kicakichipkicarthrocentesiskicshouldkicbek
icobtained.kicHowever,kicinkicthiskicsetting,kicakicmanualkiccellkiccountkicandkicdifferentialkicshouldkicbekicobtainedkicbeca


usekicankicautomatedkiccellkiccounterkicmaykicprovidekicfalselykicelevatedkiccellcounts.kicThekicresultskicofkicrevisionkicsu
rgerykicforkicakicfailedkicmetal-on-
metalkichipkicprosthesiskiccankicbekicvariable.kicThekicamountkicofkiclocalkictissuekicdestructionkicandkicthekicintegritykicofki
cthekichipkicabductorkicmechanismkiccankicgreatlykicinfluencekicoutcomes.kicInstabilitykiciskicthekicmostkiccommonkicco


mplicationkicfollowingkicrevisionkicofkicfailedkicmetal-on-metalkichipkicreplacements.
kic Questionkic4

kic Figurekic1kicshowskicthekicradiographkicandkicFigurekic2kicshowskicthekicMRIkicscankicobtainedkicfromkicakic37-year-