If a replaced joint is hot, swollen and painful with fever, or a wound over it is discharging, seek care today. Do not start antibiotics before samples for culture have been taken — doing so can make identifying the organism impossible and compromise the whole treatment.
Bacteria settling on an implant form a protective film that antibiotics cannot penetrate. This is why an infected joint replacement almost always needs surgery rather than drugs alone.
This is the most demanding problem in joint replacement surgery and the one where treatment is most often inadequate. Getting it right the first time is far easier than rescuing a failed attempt.
Bacteria reaching an implant attach to its surface and secrete a protective matrix called biofilm. Within this layer they become dormant and physically shielded, and antibiotic concentrations that would kill them in the bloodstream have almost no effect. This single fact explains why infected implants generally cannot be cured by antibiotics alone.
Infection is classified by timing. Early infection occurring within a few weeks of surgery may occasionally be treated by washing out the joint and exchanging the removable parts while keeping the implant, because biofilm has not yet fully matured. Late infection, developing months or years afterwards, almost always requires the implant to be removed.
Late infections often arrive through the bloodstream from elsewhere — a dental abscess, a skin infection, a urinary infection. This is why dental health matters for anyone with a joint replacement, and why any infection should be treated promptly rather than left.
Diagnosis rests on inflammatory markers, aspiration of the joint for cell count and culture, and multiple tissue samples taken during surgery. Some organisms are difficult to grow, which is why several samples are taken and held for prolonged culture.
This is the commonest and most damaging error in managing an infected implant. Antibiotics given before samples are taken frequently suppress bacterial growth enough that cultures come back negative, leaving the surgical team treating an unidentified organism with broad-spectrum drugs. That materially reduces the chance of eradicating the infection. If a doctor is about to prescribe antibiotics for a painful replaced joint, ask whether aspiration has been done first.
Identifying the organism is as important as confirming the infection.
Any organism grown from the joint at any point, with its antibiotic sensitivities, is enormously valuable to the surgical team. Bring the reports, the dates, and details of every antibiotic you have taken and for how long. Where cultures were negative because antibiotics had already been started, say so — that changes the plan too.
Which approach is appropriate depends mainly on how long the infection has been present and how well fixed the implant is.
Where infection presents within a few weeks of the original surgery or of the onset of symptoms, the joint is washed out thoroughly, the removable plastic parts are exchanged, and the fixed components are retained, followed by prolonged targeted antibiotics. Success depends on acting quickly and on the organism involved.
The implant and all infected tissue are removed and an antibiotic-loaded cement spacer is placed. Targeted intravenous and oral antibiotics follow for a period, usually six weeks or more. When markers have normalised, a new implant is inserted at a second operation. It is the most reliable approach and the standard for established infection.
Removal and reimplantation in the same operation, with radical removal of infected tissue and targeted antibiotics. In carefully selected patients with a known sensitive organism and good soft tissue it gives results approaching two-stage with one operation instead of two. It requires considerable experience and strict selection.
Where a patient is too unwell for major revision, long-term suppressive antibiotics may control rather than cure the infection. Fusion of the joint or, very rarely, amputation are last resorts. These are uncommon but should be discussed honestly where they are genuinely on the table.
Early infection may allow the implant to be retained. Established infection almost always requires removal.
A sensitive organism opens more options, including single-stage revision. A resistant one narrows them and lengthens treatment.
A sinus, poor skin cover or poorly controlled diabetes all push towards a two-stage approach and towards longer treatment.
Ask the surgeon how many infected revisions they perform each year and whether the hospital has a bone infection team with a microbiologist involved. In this condition that team matters as much as the surgeon.
Acute infection with systemic illness is treated where you are, urgently. Once it is controlled and the organism identified, planning definitive surgery here becomes sensible.
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Very rarely. Bacteria on an implant surface form biofilm, a protective layer that antibiotics cannot penetrate effectively. Antibiotics may suppress symptoms while treatment continues, but the infection generally returns when they stop. Cure almost always requires surgery to remove the biofilm along with the implant.
Two operations. In the first, the implant and infected tissue are removed and an antibiotic-loaded cement spacer is placed, which maintains the space and delivers antibiotic locally. You then have targeted antibiotics for six weeks or more. When inflammatory markers have normalised, a new implant is inserted at the second operation. In total, plan on three to four months.
Sometimes, and we will tell you honestly whether it is safe in your case. It depends on the spacer used, your mobility, and whether reliable antibiotic administration and monitoring are available near your home. Some patients return home for six to eight weeks and come back for the second stage. Others should stay.
Because dental infection is one of the commonest sources of bacteria reaching a joint implant through the bloodstream. Any dental problem should be treated before a new implant is put in, otherwise you risk infecting the revision too. This applies to everyone with a joint replacement, not only to those already infected.
Good with appropriate treatment, though not guaranteed, and it depends on the organism, the timing, your general health and the quality of the surgery. Resistant organisms, poorly controlled diabetes and repeated previous attempts all reduce the chance. Ask your surgeon for their own results rather than published averages.
Possibly. Where infection is diagnosed within a few weeks of surgery or of symptoms starting, and the implant is well fixed and the organism sensitive, a thorough washout with exchange of the removable parts can succeed while keeping the main components. The window is narrow, which is why prompt assessment matters so much.
Send every microbiology result you have, with organisms and sensitivities, plus CRP and ESR over time and your X-rays. Identifying the organism shapes the whole plan.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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