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Review Question - QID 7003

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QID 7003 (Type "7003" in App Search)
A 71-year-old woman with coronary artery disease underwent an uncomplicated right total hip arthroplasty for osteoarthritis 12 years ago. Her hip has functioned well until approximately 18 months ago when she noted the spontaneous onset of groin, buttock, and proximal thigh pain that is present at rest and made worse with activity. A radiograph is shown in Figure 15. What is the recommended management at this point?
  • A

Immediate admission to the hospital and emergent revision hip arthroplasty

3%

27/886

Reassurance and follow-up if symptoms worsen

1%

13/886

Repeat radiographs in 1 month

2%

22/886

Protected weight bearing with urgent revision hip arthroplasty when the patient is medically cleared

89%

786/886

A prescription for alendronate and reevaluation in 1 year

4%

33/886

  • A

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The radiograph shows significant osteolysis with loosening of the femoral component. The patient is symptomatic and surgery is indicated because of the extent of osteolysis and the loose femoral component. Reassurance and follow-up if symptoms worsen places the patient at risk for further bone loss and periprosthetic fracture. Emergent surgery is not required because the symptoms have been present for more than a year; however, urgent revision hip arthroplasty is recommended when the patient is medically cleared. While there is data to suggest that bisphosphonates may slow the progression of osteolysis in animal modes, there is no clear evidence that bisphosphonate treatment prevents the progression of osteolysis in humans. Additionally, this patient has a loose symptomatic femoral component.

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