Abstract
A 62-year-old woman with osteoarthritis presents with a 7-month history of progressively worsening left hip pain radiating to the groin, 8 months after undergoing total left-hip arthroplasty. The pain has not responded to nonsteroidal antiinflammatory drugs. Physical examination reveals a sinus tract overlying her left hip. Her leukocyte count is 8000 per cubic millimeter, and the C-reactive protein (CRP) level is 15.5 mg per liter. A radiograph shows loosening of the prosthesis at the bone–cement interface. Synovial-fluid aspirate shows 15×103 cells per cubic millimeter (89% neutrophils); cultures of an aspirate from the hip grow Staphylococcus epidermidis. How should her case be managed?
Publication types
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Research Support, N.I.H., Extramural
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Review
MeSH terms
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Anti-Bacterial Agents / therapeutic use
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Arthroplasty, Replacement, Hip*
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C-Reactive Protein / analysis
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Combined Modality Therapy
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Debridement
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Female
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Hip Prosthesis / adverse effects*
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Humans
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Middle Aged
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Prosthesis Failure
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Prosthesis-Related Infections / diagnosis
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Prosthesis-Related Infections / microbiology
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Prosthesis-Related Infections / prevention & control
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Prosthesis-Related Infections / therapy*
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Staphylococcal Infections / diagnosis
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Staphylococcal Infections / drug therapy
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Staphylococcal Infections / therapy*
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Staphylococcus epidermidis / isolation & purification*
Substances
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Anti-Bacterial Agents
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C-Reactive Protein