Fig. 3.

This figure shows an anteroposterior radiograph of a patient that had suffered a revision arthroplasty for failure of a hemiarthroplasty for fracture. A cement-in-cement fixation was used along with preventive cerclage due to the high risk of intra-operative fracture (left column). After 1.5 years the patient was diagnosed with a periprosthetic joint infection and underwent a two-stage revision arthroplasty. During the first surgery all the components were removed and an antibiotic-cemented spacer was used along with specific intravenous antibiotics targeting the intra-operative cultures (Staph. epidermidis)(middle column). After normalisation of PCR and ESR counts and a successful clinical course, the patient was revised to another cemented reverse shoulder arthroplasty. Intra-operative unexpected cultures grew (P. acnes) and antibiotic suppression was initiated (lateral column).