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CME questions based on the Mini-Symposium on “The Hip” The following series of questions are based on the Mini-Symposium on ‘‘The Hip”. Please read the articles in the Mini-Symposium carefully and then complete the self-assessment questionnaire by filling in the square cor- responding to your response to each multiple-choice ques- tion. 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 of Orthopaedics and Trauma. 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 despatched, via email, for your records. Questions 1 Currently in Europe, how many different agencies can award a ‘CE mark’ to a device (such as a new hip implant), allowing use of the marked device throughout Europe A1 B3 C8 D 31 E 83 2 Approximately what proportion of new joint replacement implants introduced in the USA reach the market through the fast e track 510 k pathway (‘me too’), obtaining clearance on the basis that they are substantially equivalent to a device already in use A 2% B 10% C 33% D 66% E 90% 3 According to NICE guidelines in the UK, what is the minimum survivorship of a new hip replacement implant at 5 years required for continuation of its clinical use A 80% B 90% C 95% D 97% E 99% 4 How many different types of femoral stem were available for implantation in the UK in 2010 A 43 B 87 C 112 D 146 E 159 5 Which parameter most commonly indicates rotational instability of a femoral stem that is being followed using radiostereometry A Anterior head migration B Distal migration C Posterior head migration D Valgus tilt E Varus tilt 6 In which of the following situations will estimates of wear using RSA methods on sequential radiographs be least reliable A Stainless steel femoral stem and titanium alloy backed polyethylene cup, no tantalum beads B Stainless steel femoral stem with stainless steel backed polyethylene cup, tantalum beads in acetabular bone C Tantalum beads in polyethylene cup, stainless steel femoral component D Tantalum beads in polyethylene cup and femoral bone, cobalt chrome femoral head E Tantalum beads in polyethylene cup, titanium femoral stem with ceramic head 7 Under standard conditions in a wear simulator, which of the following combinations has the lowest wear rates A Ceramic on ceramic B Ceramic on metal C Metal on conventional polyethylene D Metal on highly cross-linked polyethylene E Metal on metal 8 Which of the following statements concerning metal-on- metal bearing surfaces in hip arthroplasty is incorrect A Component malorientation can leave an implant devoid of a boundary layer B Friction is higher when lubricated with water than with serum C Hyaluronic acid and glycoproteins form a boundary layer in vivo that protects against wear and corrosion D They operate with a mixed lubrication regime E Wear rates are highest before the boundary layer forms 9 Which of the following is not one of the defined aims of a national joint register, as suggested by the European Arthroplasty Register and EFFORT A Failure defined as revision of at least one part of the implant B Follow up of all implants until the patient, amongst other alternatives, dies CME SECTION ORTHOPAEDICS AND TRAUMA 26:4 292 Ó 2012 Published by Elsevier Ltd.

CME questions based on the Mini-Symposium on “The Hip”

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CME SECTION

OR

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

The following series of questions are based on the

Mini-Symposium on ‘‘The Hip”. Please read the articles in

the Mini-Symposium carefully and then complete the

self-assessment questionnaire by filling in the square cor-

responding to your response to each multiple-choice ques-

tion. 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 of Orthopaedics and Trauma. 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 despatched, via email, for your

records.

Questions

1 Currently in Europe, how many different agencies can

award a ‘CE mark’ to a device (such as a new hip

implant), allowing use of the marked device throughout

Europe

A 1

B 3

C 8

D 31

E 83

2 Approximately what proportion of new joint

replacement implants introduced in the USA reach the

market through the fast e track 510 k pathway

(‘me too’), obtaining clearance on the basis that they

are substantially equivalent to a device already in use

A 2%

B 10%

C 33%

D 66%

E 90%

3 According to NICE guidelines in the UK, what is the

minimum survivorship of a new hip replacement

implant at 5 years required for continuation of its

clinical use

A 80%

B 90%

C 95%

D 97%

E 99%

4 How many different types of femoral stem were

available for implantation in the UK in 2010

A 43

B 87

THOPAEDICS AND TRAUMA 26:4 292

C 112

D 146

E 159

5 Which parameter most commonly indicates rotational

instability of a femoral stem that is being followed

using radiostereometry

A Anterior head migration

B Distal migration

C Posterior head migration

D Valgus tilt

E Varus tilt

6 In which of the following situations will estimates of

wear using RSA methods on sequential radiographs be

least reliable

A Stainless steel femoral stem and titanium alloy backed

polyethylene cup, no tantalum beads

B Stainless steel femoral stem with stainless steel backed

polyethylene cup, tantalum beads in acetabular bone

C Tantalum beads in polyethylene cup, stainless steel

femoral component

D Tantalum beads in polyethylene cup and femoral bone,

cobalt chrome femoral head

E Tantalum beads in polyethylene cup, titanium femoral

stem with ceramic head

7 Under standard conditions in a wear simulator, which of

the following combinations has the lowest wear rates

A Ceramic on ceramic

B Ceramic on metal

C Metal on conventional polyethylene

D Metal on highly cross-linked polyethylene

E Metal on metal

8 Which of the following statements concerning metal-on-

metal bearing surfaces in hip arthroplasty is incorrect

A Component malorientation can leave an implant devoid

of a boundary layer

B Friction is higher when lubricated with water than with

serum

C Hyaluronic acid and glycoproteins form a boundary

layer in vivo that protects against wear and corrosion

D They operate with a mixed lubrication regime

E Wear rates are highest before the boundary layer forms

9 Which of the following is not one of the defined aims of

a national joint register, as suggested by the European

Arthroplasty Register and EFFORT

A Failure defined as revision of at least one part of the

implant

B Follow up of all implants until the patient, amongst

other alternatives, dies

� 2012 Published by Elsevier Ltd.

CME SECTION

C Follow up of all implants until the patient, amongst

other alternatives, emigrates

D Inclusion of hip, knee, ankle and shoulder

replacements

E Registration in a central database of all revision joint

replacements

10 In a simulator, which of the following is associated

with the greatest volumetric wear in metal-on-metal

hip arthroplasty components

A Full hemisphere 36 mm bearing, translational

malposition

B Full hemisphere 36 mm bearing, 65� rotational

malposition

C Full hemisphere 36 mm bearing, standard walking

conditions

D Sub hemisphere 39 mm bearing, standard walking

conditions

E Sub hemisphere 39 mm bearing, 65� rotational

malposition

11 Which of the following procedures is not covered by

the national requirement to collect patient reported

outcome measures that has been part of the Standard

NHS contract for acute services since 2009

A Groin hernia

B Instrumented spinal fusion

C Total hip replacement

D Total knee replacement

E Varicose vein surgery

12 Which of the following is not, at the time of publication

of this issue, a function of the National Joint Registry in

the UK

A Allows rapid identification of affected surgeons and

patients in the event of a batch recall of implants

B Allows surgeons to check their personal 3-year revi-

sion rate

C Provides feedback directly to hospitals on the revision

rates of surgeons working in the hospital

ORTHOPAEDICS AND TRAUMA 26:4 293

D Provides feedback directly to individual surgeons in

the form of a funnel plot

E Provides feedback directly to manufacturers on the

performance of the implants they supply

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.