CME SECTION

OR

CME questions based on the Mini-Symposium on “KneeArthroplasty”

The following series of questions are based on the Mini-

Symposium on ‘‘Knee Athroplasty”. Please read the articles

in the Mini-Symposium carefully and then complete the self-

assessment questionnaire by filling in the square corre-

sponding to your response to each multiple-choice question.

After completing the questionnaire, either post or fax the

answer page to the Orthopaedics and Trauma Editorial Office

at the address at the bottom of the RESPONSE sheet.

Please photocopy this page if you wish to keep your copy

ofOrthopaedics andTrauma.Replies received before the next

issue of the journal is published will be marked and those

reaching an adequate standard will qualify for three external

CME points. You will be notified of your marks and a CME

certificate will be dispatched, via email, for your records.

Questions

1 With the knee in flexion, approximately how far below

the inferior pole of the patella does the superior branch

of the saphenous nerve pass?

A 10 mm

B 25 mm

C 50 mm

D 60 mm

E 70 mm

2 Which of the following is not a cause of flexion

instability after knee replacement

A Excessive bone removal from the distal femur

B Excessive posterior tibial slope

C Inadequate filling of the flexion space by the implant

D Late failure of the posterior cruciate ligament

E Undersizing of the femoral component

3 Which of the following statements concerning the

Oxford Knee Score is incorrect

A It is a sensitive score when used in patients with

primary knee replacement

B It is a sensitive score when used in patients with revi-

sion knee replacement

C It is internally consistent

D It is sensitive to clinically important changes in

a patient over time

E It is useful when comparing outcomes between groups

of patients with different knee pathology

4 Approximately what proportion of patients who undergo

evacuation of a postoperative haematoma within 30

days of total knee replacement subsequently develop

a deep infection

A 2%

B 5%

THOPAEDICS AND TRAUMA 26:2 144

C 9%

D 14%

E 21%

5 Which of the following laboratory investigations is the

most sensitive and specific marker for diagnosing

infection after total knee replacement

A CRP

B ESR

C IL6

D Procalcitonin

E TNFa

6 In the case of early postoperative infection after total

knee replacement, up to how long after implantation is

it reasonable to treat by debridement with retention of

the original components

A Should not be done

B 1 week

C 2 weeks

D 6 weeks

E 6 months

7 Which of the following statements concerning the

relationship between procedure volume and outcome is

correct for revision knee replacement

A There is no reported difference in the risk of adverse

outcome when low-volume units and specialized high

volume centres are compared

B The risk of an adverse outcome is 10% lower in district

general hospitals than in teaching centres

C The risk of adverse outcomes is 10% lower in high

volume units than in low volume units

D The rate of adverse outcomes is twice as high in general

hospitals when compared to specialist hospitals

E There are 10 times as many adverse outcomes in

general hospitals when compared to specialist centres

8 What is the approximate risk of temporary nerve palsy

when the tourniquet time is greater than 2 h in revision

knee replacement

A 1%

B 6%

C 11%

D 16%

E 21%

9 What is the threshold for displacement of the joint line

proximally or distally in knee replacement, above which

the outcome is significantly affected

A 2 mm

B 4 mm

C 6 mm

� 2012 Published by Elsevier Ltd.

CME SECTION

D 8 mm

E 10 mm

10 If patellar blood flow is assessed by Doppler

flowmetry after total knee replacement approximately

what proportion with be shown to suffer at least

transient ischaemia

A 2%

B 5%

C 10%

D 15%

E 20%

11 When carrying out a revision knee replacement faced

with several old scars, which of the following best

describes the appropriate selection of the new incision

A A new incision, avoiding old scars, is preferred to

reduce the infection risk

B Short transverse scars should be crossed obliquely to

create a zigezag approach

C Short transverse scars should be incorporated into the

new scar as transverse incisions in a zigezag approach

D Where possible the most medial of previous scars

should be re-used

E Where possible the most lateral of previous scars

should be re-used

12 Which of the following patterns of bone defect in

a case of revision knee replacement would best be

treated using a trabecular metal cone

A Contained defect of the posteromedial tibial meta-

physis of 1.5 cm with poor posterior bone stock

B Contained defect of the lateral tibial plateau of 1.5 cm

C Contained defect of the medial tibial plateau of 1.5 cm

D Uncontained defect of the lateral tibial plateau of 2.5

cm with good anterior and posterior bone stock

ORTHOPAEDICS AND TRAUMA 26:2 145

E Uncontained defect of themedial tibial plateau of 2.5 cm

with good anterior and posterior bone stock

Please fill in your answers to the CME questionnaire above in

the response section provided to the right. A return address

and fax number is given below the response section.

Responses

Please shade in the square for the correct answer.

1 A B C D E

2 A B C D E

3 A B C D E

4 A B C D E

5 A B C D E

6 A B C D E

7 A B C D E

8 A B C D E

9 A B C D E

10 A B C D E

11 A B C D E

12 A B C D E

Your details (Print clearly)

NAME.....................

ADDRESS....................

........................

EMAIL.....................

RETURN THE COMPLETED RESPONSE FORM by fax to

þ44-113-392-3290, or by post to CME, Orthopaedics and

Trauma, Academic Department of Orthopaedic Surgery,

“A” Floor Clarendon Wing, Leeds General Infirmary, Great

George Street, Leeds LS1 3EX, UK.

� 2012 Published by Elsevier Ltd.