Figure 2.

Hip radiographs: periprosthetic joint infection (PJI) with history of three prior debridement surgeries and systemic antibiotics. (A) First Hip spacer (Girdlestone); (B) Status post second spacer exchange (third spacer) for persistent infection; (C) Status post third spacer exchange: failure of intended reimplantation. Clinical history: First exchange occurred after recurrence of fever, elevated CRP, local signs of hip infection and positive urinalysis s/p two-weeks off antibiotics. Of note, purulence was observed during the first exchange surgery. Second Exchange occurred after a purulent drainage, with an aspiration culture growing methicillin-resistant Staphylococcus aureus (MRSA). After a third spacer exchange, the intra-operative cultures grew Klebsiella Pneumoniae.