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Figure A depicts the intraoperative findings during a revision total hip arthroplasty (THA) in a patient with chronic pain for the last two years after undergoing his index THA 10 years ago. Workup for infection was negative. The acetabular and femoral components are assessed to be well-fixed intraoperatively. Which of the following describes the best treatment option?
Suppressive intravenous antibiotics
Two-stage revision arthroplasty
Irrigation and debridement
Acetabular component revision
Revision to new ceramic femoral head with titanium sleeve
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An 81-year-old man reports a year of worsening right groin pain and swelling. A current radiograph and recent MRI are shown in Figures A and B, respectively. ESR and CRP are within normal limits. Aspiration yields 8cc of black liquid with an automated cell count of 7,000 WBC. Manual cell count demonstrates 1,500 WBC and 62% neutrophils. Serum cobalt levels are 12ppb and chromium levels at 2ppb. What is the next best step in management?
Greater trochanteric bursa injection
Revision arthroplasty with exchange of both components to long modular diaphyseal engaging stem and multihole acetabular cup
Revision arthroplasty with exchange of both components to long modular diaphyseal engaging stem and constrained acetabular component
Revision arthroplasty with antibiotic spacer placement and subsequent revision arthroplasty
Revision arthroplasty with conversion to ceramic head with titanium sleeve and new polyethylene liner