Intended for healthcare professionals

Clinical Review

Diagnosis and management of prosthetic joint infection

BMJ 2009; 338 doi: (Published 29 May 2009) Cite this as: BMJ 2009;338:b1773
  1. Philippa C Matthews, specialist registrar infectious diseases/microbiology, clinical research fellow123,
  2. Anthony R Berendt, consultant in infectious diseases12,
  3. Martin A McNally, consultant orthopaedic surgeon in limb reconstruction1,
  4. Ivor Byren, consultant in infectious diseases12
  1. 1Bone Infection Unit, Nuffield Orthopaedic Centre NHS Trust, Headington, Oxford OX3 7LD
  2. 2Department of Infectious Diseases, Oxford Radcliffe Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU
  3. 3University of Oxford, Peter Medawar Building for Pathogen Research, Oxford OX1 3SY
  1. Correspondence to: P C Matthews p.matthews{at}

    Joint replacement is safe, cost effective,1 and widely undertaken. Most prosthetic joint replacements are hips and knees; more than 130 000 people underwent such procedures in England and Wales in the 12 months from April 2006.w1 Subsequent prosthetic joint infection is uncommon—the incidence varies between 0.6% and 2% per joint per year.2 3 4 5 However, this complication is associated with substantial morbidity and economic cost ($30 000 (£20 500; €22 800) to $50 000 per patient).3 4 6 w2 The diagnosis of prosthetic joint infection is difficult,w2 because symptoms, signs, and investigations may all be non-specific.7 w3 Defining diagnostic criteria and optimum management is complicated by patient heterogeneity and the small numbers in many published studies.w4 However, prompt recognition and diagnosis of prosthetic joint infection facilitates timely intervention to salvage infected joints, preserve joint function, prevent morbidity, and reduce costs.

    Summary points

    • Early diagnosis of prosthetic joint infection reduces morbidity and improves outcomes

    • Infection is eradicated and joint function is preserved in most patients who receive appropriate combined surgical and medical treatment

    • A multidisciplinary team is often needed for optimal diagnosis, treatment, and rehabilitation; specialist referral may be required.

    • Well fixed implants can be salvaged by aggressive debridement, antibiotics, and implant retention

    • Antibiotics are usually needed for three to six months if the prosthesis is retained, or for up to six weeks after revision arthroplasty

    Sources and selection criteria

    We performed Medline searches between November 2008 and January 2009 using the search terms “prosthetic joint” and “arthroplasty” combined with “infection”, “guidelines”, “septic arthritis”, “infection diagnosis”, “infection epidemiology”, and “infection revision arthroplasty”. Where possible, we focused on articles published in the past five years and restricted our search to literature published in English. We also drew from the experience of, and articles and documents published by, our multidisciplinary bone infection unit in the United …

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