PMC5458697_01
Anteroposterior radiograph pelvis on admission.
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F1
Normal range 0-5 mg/ml (Fig. 1).
Anteroposterior radiograph pelvis 1 week following admission.
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F2
He initially responded well with falling inflammatory markers, apyrexia, pain reduction, and a dry healing wound (Fig. 2).
Magnetic resonance imaging hip 3 weeks post-admission.
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F3
Despite this positive response, however, the wound ooze persisted (Fig. 3).
Anteroposterior radiograph pelvis 1 day post 1st stage replacement.
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F4
Despite remaining clinically and biochemically well, the wound failed to progress, and therefore a formal first stage excision arthroplasty was performed 8 weeks following admission, with a Biomet stage one select reinforced cement hip spacer impregnated with gentamicin and vancomycin through an anterolateral approach (Fig. 4).
Anteroposterior radiograph pelvis 6 weeks post 1st stage replacement.
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F5
Oral fluconazole 400 mg OD was escalated to intravenous anidulafungin 50 mg OD and antibiotic therapy discontinued following a 10-week course (Fig. 5).
Anteroposterior radiograph pelvis 2 days post 2nd stage replacement.
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F6
Revision copal cement, impregnated with gentamicin and clindamycin as standard was supplemented with 600 mg grams of anidulafungin antifungal powder (Fig. 6).
Anteroposterior radiograph pelvis at final follow-up.
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F7
Nine months postprocedure, he is currently functioning with pain-free range of motion of the right hip with no complications; however, we must be aware that later recurrence of infection is still a possibility so ongoing follow-up will be required (Fig. 7).