Review Question - QID 218168

A 65-year-old male is transferred to a tertiary care facility with concerns of sepsis secondary to periprosthetic joint infection. Interventional radiology performs an aspiration (Figure A) which is positive for chronic periprosthetic joint infection. He undergoes explant, antibiotic-imbued cementation of the resultant bone defect, and spacer placement with adjunctive antibiotic beads (Figures B & C). Over the next 6 months, the patient completes a prolonged course of IV antibiotics followed by an antibiotic holiday. He obtains updated labs demonstrating a serum ESR of 10 mm/hr (normal 0-22 mm/hr) and CRP of 0.4 mg/dL (normal <0.5mg/dL). A hip aspiration is performed (Figure D) resulting in negative alpha defensive, negative leukocyte esterase, synovial WBC of 1,000 cells/mL, and 74% neutrophils. A CT scan confirms a subtle fracture nonunion between his anterior and posterior columns beneath the cemented pelvic defect. He continues to endorse groin and thigh pain limiting his ability to perform transfers or walk. He would like to return to a reasonable level of independent functioning. Which of the following would be the most appropriate next step in management?