Overview

Infection is an uncommon but serious complication that can occur after total joint replacement surgery of the hip, knee or shoulder. When infection develops in the tissues surrounding an artificial joint, it is often called a periprosthetic joint infection (PJI).

A joint replacement infection can develop soon after surgery or months or even years later. Because bacteria can attach to the surfaces of an artificial joint, these infections may require specialized treatment beyond the antibiotics used for many other types of infection. Early evaluation is important when symptoms suggest a possible problem.

Symptoms & Causes

Symptoms can vary depending on when and how the infection develops. Possible warning signs include increased or persistent pain around a replaced hip, knee, or shoulder; swelling, warmth, or redness around the joint; wound drainage; fever or chills; and increasing stiffness or difficulty using the joint.

Some infections develop around the time of the original surgery. In other cases, bacteria may reach an artificial joint through the bloodstream from an infection elsewhere in the body.

Joint pain after hip, knee or shoulder replacement does not necessarily indicate infection. Implant loosening, instability, fracture and other conditions can produce similar symptoms, which makes an accurate diagnosis especially important.

Affected Populations

Any patient with an artificial hip, knee or shoulder can develop a periprosthetic joint infection, although certain medical conditions and circumstances may increase risk. A patient's overall health, previous surgeries and the timing and nature of the infection are among the factors considered when evaluating treatment options.

Diagnosis

Diagnosis typically combines a physical examination with imaging and laboratory testing. Blood tests may be used to look for signs of inflammation. In some cases, fluid is removed from the joint and analyzed for evidence of infection. X-rays and other imaging may also help determine whether the implant or surrounding bone has been affected.

Treatment

Treatment depends on factors including how long the infection has been present, the type of bacteria involved, the condition of the implant and surrounding tissues, and the patient's overall health.

Some infections identified early may be treated with surgery to thoroughly clean the joint while retaining certain implant components, combined with antibiotics. Other infections may require removal of part or all of the existing replacement and Total Joint Revision Surgery. Treatment may occur in one operation or in stages. Because periprosthetic joint infections can be complex, treatment is individualized to address both the infection and the function of the replaced joint.