Arthroplasty: wear particle osteolysis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Arthroplasty: wear particle osteolysis

Sample item

Ten years after a total hip replacement, a patient has thigh pain and radiographs show progressive radiolucency around the acetabular cup, with no features of infection. What is the main mechanism?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Macrophage response to polyethylene wear particles leading to osteoclastic bone resorption

Microscopic polyethylene wear particles are phagocytosed by macrophages, which release cytokines that activate osteoclasts. The resulting periprosthetic osteolysis loosens the components, which is called aseptic loosening. Infection must still be excluded with markers and aspiration.

Option by option

  • A. Gouty crystal deposition

    Gouty crystals do not cause progressive periprosthetic lucency.

  • B. Macrophage response to polyethylene wear particles leading to osteoclastic bone resorption (correct)

    Correct. Particle-induced osteolysis is the usual cause of late aseptic loosening.

  • C. Failure of the cement to set

    Cement failure at setting would cause early, not late, loosening.

  • D. Bacterial biofilm formation

    Biofilm infection would show raised inflammatory markers and is excluded here.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is B, Macrophage response to polyethylene wear particles leading to osteoclastic bone resorption. Microscopic polyethylene wear particles are phagocytosed by macrophages, which release cytokines that activate osteoclasts.

Why is "Gouty crystal deposition" not the answer?

Gouty crystals do not cause progressive periprosthetic lucency.

Why is "Failure of the cement to set" not the answer?

Cement failure at setting would cause early, not late, loosening.

Why is "Bacterial biofilm formation" not the answer?

Biofilm infection would show raised inflammatory markers and is excluded here.

What concept does this question test?

It tests Arthroplasty: wear particle osteolysis in Orthopaedics. The resulting periprosthetic osteolysis loosens the components, which is called aseptic loosening. Infection must still be excluded with markers and aspiration.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Arthroplasty: wear particle osteolysis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.