■ ORTHOPEDICS hyperguide self assessment

Each month ORTHOPEDICS gives readers the opportunity to assess their knowledge
on orthopedic-related topics. This month, test your knowledge on hip & knee.
Edited by Frank J. Frassica, MD

This month’s module:

Hip & Knee

1. The most common organism implicated in an B. 25%.

infected total hip replacement is: C. 35%.
A. Staphylococcus aureus. D. 40%.
B. Streptococcus. E. 65%.
C. Staphylococcus epidermidis.
D. Escherichia coli. 4. Which of the following is not associated with lateral
E. Salmonella typhi. tracking of the patellar component in total knee
arthroplasty:
2. Organisms survive on biosynthetic surfaces, such as A. Medial patellar component position.
total hips, because of: B. External rotation of the femoral component.
A. Sulphate molecules on the surface. C. Medial placement of the femoral component.
B. Their natural occurrence in the human body. D. Internal rotation of the tibial component.
C. Polysaccharide biofilm on the surface. E. Use of a posterior-stabilized prosthesis.
D. They are protected by the sodium hyalurinate.
E. Mucopolysaccharide present in the synovial fluid. 5. The minimum thickness of polyethylene required for
the tibial component of a total knee prosthesis is:
3. Preoperatively, what percentage of patients A. 4 mm.
undergoing total hip replacement have methicillin- B. 6 mm.
resistant Staphylococcus aureus (MRSE) organisms C. 8 mm.
on their skin: D. 10 mm.
A. 10%. E. 12 mm.

For answers see page 936

Visit the ORTHOPEDICS hyperguide ™ website and test your skills on this
topic or any other orthopedic-related topics. Choose from a variety of interactive, informative tutorials led
by Chief Medical Editors, Frank J. Frassica, MD, and Robert D. D'Ambrosia, MD. From online lectures to
hundreds of self-test questions, the Orthopedics hyperguide provides relevant information for orthopedic
professionals. The Orthopedics Hyperguide is sponsored by Vindico Medical Education and is supported by
an educational grant from Stryker.

www.ortho.hyperguides.com

DECEMBER 2009 | Volume 32 • Number 12 935

■ self assessment
Answers to Self Assessment
Questions appear on page 935
1. C. Staphylococcus epidermidis.
Reference: Garvin K, Pellicci PM, Tria AJ, eds. Orthopaedic
Knowledge Update: Hip and Knee Reconstruction 2. Rose-
mont, IL: American Academy of Orthopaedic Surgeons;
2000:137.
Discussion: Staphylococcus epidermidis accounts for 50% to
75% of all arthroplasty infections. This is the most common
organism cultured from the skin of preoperative patients.
2. C. Polysaccharide biofilm on the surface.
Reference: Garvin K, Pellicci PM, Tria AJ, eds. Orthopaedic
Knowledge Update: Hip and Knee Reconstruction 2. Rose-
mont, IL: American Academy of Orthopaedic Surgeons;
2000:138.
Discussion: Antibiotic resistance, the organism’s ability to
form a glycocalyx or polysaccharide biofilm, and a slime layer
enable the organism to survive on implants. This is one of the
reasons why it is difficult to clear up an infection using only
antibiotics.
3. B. 25%.
Reference: Garvin K, Pellicci PM, Tria AJ, eds. Orthopaedic
Knowledge Update: Hip and Knee Reconstruction 2. Rose-
mont, IL: American Academy of Orthopaedic Surgeons;
2000:139.
www.ortho.hyperguides.com
936
Discussion: Preoperatively, 25% of skin swabs taken in
100 patients undergoing total hip replacement were MRSE
resistant. This is probably a direct result of the overuse of
antibiotics by practicing physicians.
4. C. Medial placement of the femoral component.
Reference: Beaty JH, ed. Orthopaedic Knowledge Update 6.
Rosemont, IL: American Academy of Orthopaedic Surgeons;
1999:566.
Discussion: All of the above answers, except medial place-
ment of the femoral component, can cause lateral tracking of
the patellar component.
5. C. 8 mm.
Reference: Beaty JH, ed. Orthopaedic Knowledge Update 6.
Rosemont, IL: American Academy of Orthopaedic Surgeons;
1999:567.
Discussion: Laboratory studies have demonstrated that a
minimum of 12 mm polyethylene thickness is required to
minimize cold extrusion. However, placement of a 12-mm
polyethylene component would necessitate removal of an
excessive amount of host bone. Currently, the US Food and
Drug Administration requires use of at least 8 mm polyethyl-
ene thickness in total knee arthroplasty.
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