title: Infection of a total hip arthroplasty with actinomyces israelii: Report of a case.
abstract: BACKGROUND
  Infection of following total hip arthroplasties can be classified based on the timing of infection. Late infections with Actinomyces israelii are extremely rare with only 3 previously reported cases in literature. We present another case of a late infection with Actinomyces israelii in a total hip arthroplasty 9 years following implantation.
  
  
  METHODS
  A 71-year-old male with diabetes mellitus presented with right hip pain 9 years following a total hip arthroplasty. Physical examination revealed localised pain and biochemical investigations showed elevated inflammatory markers. X-rays were suspicious for infection and a collection around the prosthesis was confirmed by MRI scan. The patient underwent debridement and removal of prosthesis. Peri-operative specimen cultures isolated Actinomyces israelii. The patient responded to a combination of vancomycin followed by ciprofloxacin and linezolid therapy before undergoing a successful second-stage reimplantation surgery.
  
  
  CONCLUSIONS
  This is the first reported case of late haematogenous infection by Actinomyces israelii in a total hip arthroplasty in a patient with diabetes mellitus as the only risk factor. The patient was successfully treated with antibiotic therapy and two-stage reimplantation arthroplasty.
authors.affiliation: University Department of Orthopaedic Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Feiran
authors.initials: F
authors.lastname: Wu
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Marriage
authors.forename: Adil
authors.initials: A
authors.lastname: Ismaeel
authors.forename: Eric
authors.initials: E
authors.lastname: Masterson