Case Report ManaginganAcuteandChronicPeriprostheticInfection CristianBarrientos,MaximilianoBarahona,andRodrigoOlivares Orthopaedic Department at Hospital Clinico Universidad de Chile, Santos Dumontt 999, Santiago, Chile Correspondence should be addressed to Maximiliano Barahona; maxbarahonavasquez@gmail.com Received 16 July 2017; Accepted 27 September 2017; Published 14 November 2017 Academic Editor: George Mouzopoulos Copyright © 2017 Cristian Barrientos et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A case report of a 65-year-old female with a history of right total hip arthroplasty (THA) in 2007 and left THA in 2009 was presented. She consulted with our institution for the first time, on December 2013, for right hip pain and fistula on the THA incision. It was managed as a chronic infection, so a two-stage revision was performed. First-time intraoperative cultures were positive for Staphylococcus aureus (3/5) and Proteus mirabilis (2/5). ree weeks after the second half of the review, it evolved with acute fever and pain in relation to right hip. No antibiotics were used, arthrocentesis was performed, and a coagulase-negative staphylococci multisensible was isolated at the 5th day. Since the germ was different from the first revision, it was decided to perform a one-stage revision. One year after the first review, the patient has no local signs of infection and presents ESV and RPC in normal limits. e indication and management of periprosthetic infections are discussed. 1.Introduction Periprosthetic infection is a complication that follows arthroplasty, whose incidence varies between 0.4 and 2% in the most recent studies [1]: 40% of infections occur within the first 2 years [2] and correspond to the main cause of primary early failure (<5 years) [3]. ey are classified according to the time of evolution (Table 1). Among the risk factors (RFs) described are higher body mass index (BMI) at 30, diabetes mellitus (DM), use of corticoids, rheumatoid arthritis, tobacco use, cancer, MRSA colonization, chronic renal failure, and anemia. e risk increases directly in relation to the number of associated RFs [4–6]. 2.ClinicalHistory A 65-year-old female ECF patient had a history of obesity and noninsulin-requiring diabetes mellitus, operated in 2007 for left total hip arthroplasty (THA) and in 2009 for right THA (both surgeries were performed in another center). Her first visit to Clinical Hospital of Universidad de Chile, in December 2013, was for a 2-year history charac- terized by pain and functional impotence in the right hip, associated with recurrent febrile episodes and fistula in relation to scarring of the THA. In another center, it was managed with surgical lavage, debridement, and prolonged antibiotic treatments. General examinations, dated De- cember 2013, include erythrocyte sedimentation rate (ESR, 54) and C-reactive protein (CRP, 30 mg/L). Chronic periprosthetic infection was diagnosed (Tables 1 and 2). It was decided to suspend antibiotics (atb), and arthrocentesis under radiography was programmed after 3 weeks of the atb suspension. Positive polymicrobial culture was obtained from arthrocentesis for Proteus mirabilis and multisensitive Staphylococcus aureus. It was decided to perform an arthroplasty revision in two stages. First stage was scheduled for March 2014. Fistula re- section, complete prosthesis removal, surgical lavage and debridement, tissue cultures, femoral intramedullary reaming, and vancomycin cement spacer were performed. Figure 1 shows the postoperative radiograph. e cultures of intra- operative tissues obtained were positive for Staphylococcus aureus (3/5) and Proteus mirabilis (2/5), confirming the bacteriological diagnosis of arthrocentesis. After surgery, an- tibiotic treatment with intravenous vancomycin was restarted for 2 weeks, switching to oral ciprofloxacin for 40 days. It evolves favorably, without pain, without signs of systemic infection in the surgery wound. Figure 2 shows the Hindawi Case Reports in Orthopedics Volume 2017, Article ID 6732318, 5 pages https://doi.org/10.1155/2017/6732318