Periprosthetic Joint Infection

A periprosthetic joint infection (PJI) is an infection involving a joint replacement (such as a hip, knee, shoulder or elbow replacement) and the tissues around it. It can occur soon after surgery or develop months or years later.

PJI is important to recognise early because it can cause significant pain, reduced function, and in some cases serious illness. Some presentations require urgent assessment, particularly if there are signs of sepsis or rapidly worsening symptoms.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment and can coordinate the appropriate investigation and onward management pathway, including urgent referral where needed.

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Types of Periprosthetic Joint Infection

PJI is often described by timing and pattern:

• Early / acute PJI
  Typically occurs in the first weeks after surgery, often with increasing pain, wound problems, swelling and inflammation. (boa.ac.uk)
• Late / chronic PJI
  May develop months or years after surgery. Symptoms can be more subtle, such as persistent pain, stiffness, recurrent swelling, or reduced function. (boa.ac.uk)
• Acute haematogenous PJI
  Infection spreads through the bloodstream to a previously well-functioning joint replacement, sometimes after another infection elsewhere in the body.

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Common Causes and Risk Factors

PJI occurs when bacteria (or, less commonly, other organisms) contaminate or spread to the joint replacement. Implants can allow organisms to form a protective layer (biofilm), which can make infections harder to treat and one reason early assessment matters.

Risk can be higher in people with:

• Diabetes or poor blood sugar control
• Reduced immunity (including immunosuppressive medication)
• Smoking
• Obesity
• Previous surgery on the same joint
• Wound healing problems after surgery
• Other active infections (in some cases)

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Symptoms of Periprosthetic Joint Infection

Symptoms vary depending on how quickly the infection develops, but common features include:

• Increasing joint pain (often new or worsening)
• Swelling around the joint
• Redness or warmth
• Wound problems, including leakage or cloudy fluid/pus
• Stiffness, reduced range of movement, or difficulty weight-bearing
• Fever or feeling unwell (more likely in acute infection) (CDC)

Some chronic infections present without fever and may mainly cause persistent pain and poor function.

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Diagnosis at Royal Buckinghamshire Hospital

Assessment focuses on confirming infection, identifying the organism where possible, and determining how urgent management needs to be.

Your consultant may recommend:

• Detailed history and examination of the joint and any surgical wound
• Blood tests to look for inflammation (commonly CRP and ESR as part of screening) (orthopedicreviews.openmedicalpublishing.org)
• Imaging where appropriate (X-ray, and in selected cases other scans)
• Joint aspiration (taking a sample of joint fluid) for cell count and microbiology culture in appropriate cases
• Blood cultures if you are systemically unwell

You may also be assessed for signs of sepsis, with urgent escalation if needed.

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Treatment & Management

Treatment depends on how long the infection has been present, the organism involved, implant stability, your overall health and the affected joint. Management is typically coordinated with an orthopaedic and microbiology team.

Treatment options may include:

Antibiotics

Antibiotics are used in most PJIs, usually guided by cultures where possible. The duration and route (tablets vs intravenous) depends on clinical factors and the treatment strategy.

DAIR procedure (Debridement, Antibiotics and Implant Retention)

In selected cases (often early/acute infections), the joint may be surgically washed out and infected tissue removed while keeping the implant in place, combined with antibiotics.

Revision surgery (exchange of the implant)

Where infection is established or the implant is loose/unstable, revision surgery may be recommended. This may be:

• Single-stage revision (remove and replace in one operation) in selected cases, typically with suitable organisms and good soft tissue conditions (boa.ac.uk)
• Two-stage revision (remove the implant, treat infection, then re-implant later), which is widely used for complex or difficult infections (PMC)

Supportive care and rehabilitation

Physiotherapy and rehabilitation planning can help restore mobility and function after treatment, tailored to your pain levels, stability and recovery timeline.

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When to seek urgent help

Seek urgent same-day medical advice if you have a joint replacement and develop:

• Rapidly worsening joint pain, swelling, redness or heat
• Wound leakage, cloudy drainage or pus
• Fever, chills, confusion, fast breathing/heart rate, or you feel very unwell (possible sepsis)
• Sudden inability to weight-bear, new deformity, or severe pain after a fall (CDC)

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If you are concerned about pain, swelling, redness, or wound changes after a joint replacement, contact Royal Buckinghamshire Hospital for assessment and guidance. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly any costs will always be discussed.