Case 258

Medical History

Male patient, 56 years old, presented a severe acute exacerbation of chronic low back pain (present for 3 months), with irradiation to left inguinal region. He denies previous trauma, but underwent total knee arthroplasty (TKA) for treatment of osteoarthritis thirty days ago. On examination: Poor oral hygiene. Painful palpation of left paravertebral lumbar region. No neurological deficits. Right knee with moderate joint heat and effusion, with no fistula. Laboratory tests: CRP: 232 mg/L, ESR: 115 mm/h and leukocytosis with left shift. Imaging studies of lumbar spine were performed (Figures 1, 2 and 3).

Based on clinical data and imaging tests, what is the most likely sequence of events in this case?

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