Joint Replacement Infection

A serious and dangerous complication after joint replacement surgery

Table of Contents
View All
Table of Contents

Joint replacement infections are a dangerous surgical complication after knee and hip replacement. In these cases, bacteria can adhere to the implant itself, which makes the infection difficult to treat. Even if caught early, joint replacement infections sometimes require the implant to be removed or replaced—a serious and complex surgery that can take months to recover from.

Doctors operating on a patient
Squaredpixels / Vetta / Getty Images

These infections are rare, occurring in 1% to 2% of patients. But given that joint replacement surgery has become one of the world's most common elective procedures, this means that thousands of people are affected each year.


Joint replacement infection symptoms don't differ much from traditional infection symptoms, so patients should be vigilant for the following:

  • Increased pain and stiffness in the joint
  • Redness, warmth, and/or swelling around the incision
  • Wound drainage
  • Fever


Most patients have no identifiable cause for developing an infection. It can happen during the procedure or virtually anytime thereafter, even years later. Possible causes can be bacteria entering the body through a cut or even another surgical procedure later on.

Some known factors raise your risk:

Even after a successful operation, patients remain at risk for infection from transient bacteria entering the bloodstream. Because of this, joint replacement patients should take antibiotics before common but invasive procedures such as dental work or colonoscopies.


If you suspect an infection, see a healthcare provider immediately. Most diagnoses include a physical exam, X-rays and/or bone scans, and blood tests to look for an immune response (white blood cells) as well as inflammation.

Your healthcare provider may also use a needle to draw fluid from the (potentially) infected joint and test for bacteria.


Fighting an infection requires blood flow to deliver antibiotics and immune cells to the affected area. Joint replacement infections are difficult to treat because the bacteria can attach to the prosthetic itself and form a film layer, which, in addition to the absence of blood supply to the metal and plastic implants, forms a barrier that prevents antibiotics from penetrating the infection.

Treatment includes the following:

Surgical Cleansing (Debridement)

Infected joint replacements usually require surgery to excise infected tissue and manually scrub the implant surfaces to remove the bacteria and film layer. However, even with aggressive antibiotic and surgical treatment, the infection may persist.

Removal and Replacement

Many times the only way to cure an infected joint replacement is through a multi-stage process. First, the infected implants are removed, the joint cavity is cleansed of debris and infected tissue, and a temporary spacer is placed to keep the bones aligned. The patient then undergoes 6-8 weeks of IV antibiotic treatment until repeat lab work and joint fluid testing confirms the infection has been eradicated. Then, a second surgery is performed to remove the spacer and place a new joint replacement in a procedure that is called a joint replacement 'revision'.

This lengthy and arduous process is why joint replacement infections are such a serious problem.


While joints can often become infected after surgery, surgical staff have routine procedures in place to prevent infections after joint replacement surgery.

The most common measures taken to prevent joint replacement infections are:

  • Antibiotics before and after surgery: Antibiotics are given within one hour of the start of surgery and continued for a short period following the procedure. Different antibiotics may be used depending on the patient's individual history of infection, allergies to specific medications, and other concerns.
  • Short operating time and minimal operating room traffic: Surgical efficiency can help lower infection risk by limiting the time the joint is exposed. Limiting the number of operating room personnel entering and leaving the room is also thought to decrease risk.
  • Use of strict sterilization techniques: Care is taken to ensure the operating site is sterile. Reusable instruments are sterilized in an autoclave and not exposed to any contamination. The implants are packaged to ensure their sterility. Disposable items are sterile and discarded after use.

A Word From Verywell

Infection after joint replacement surgery is among the most feared complications of this surgical procedure. If you experience any symptoms, contact your healthcare provider immediately.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Izakovicova P, Borens O, Trampuz A. Periprosthetic joint infection: current concepts and outlook. EFORT Open Rev. 2019;4(7):482-494. doi:10.1302/2058-5241.4.180092

  2. American Academy of Orthopaedic Surgeons. Joint Replacement Infection.

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.