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One-stage revision
89%
3959/4425
Irrigation and debridement with polyethylene spacer exchange
3%
128/4425
Antibiotic impregnated cement spacer placement
1%
30/4425
Two-stage revision
6%
253/4425
Broad-spectrum, empiric oral antibiotics
34/4425
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The history, radiographs, and laboratory values are consistent with aseptic loosening. The lateral radiograph demonstrates a thin cement mantle that has separated from the prosthesis. The question stem details that infection is not likely given the normal serology and aspirate values. A one-stage revision of the arthroplasty components is the most appropriate next step in management among the options provided. Brown and Bartel present a Level 5 review of the intrinsic and extrinsic factors that can effect wear behavior in arthroplasty bearing surfaces. They state that increased sliding distance, third body wear, and impingement can be sources for accelerated wear rates of bearings. Gonzalex and Mekhail present a Level 5 review discussing the etiologies for a failed joint arthroplasty. Sources identified for continued pain were aseptic loosening, component failure, patellar dysfunction, infection, or complex regional pain syndrome.
4.3
(20)
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