Infection of a Hip Replacement

Treatment of Infection After Hip Replacement Surgery

Hip replacement prosthesis
Infection of a hip replacement is a risk of surgery. Image © Medical Mulitmedia Group

Hip replacement surgery is a commonly performed operation, that is increasing every year in numbers.  As the surgical implants become better, and the surgical technique is perfected, more surgeons are offering hip replacement as a treatment for severe hip arthritis to a broader group of patients.  Younger patients are having hip replacements, older patients are having hip replacements, and sicker patients are having hip replacement.

  As the number of patients having surgery is rising, we are also seeing more of the complications from this major surgery.

One of the most significant complications of a joint replacement surgery is an infection of the replacement.  This is a serious complication that can have significant impacts including prolonged treatment, additional surgery, and less successful outcomes from the replacement.  Therefore, every effort is made to reduce the chance of infection, and take steps to prevent this complication of surgery.  When infections do occur after hip replacement, they should be treated quickly and aggressively to attempt to contain the effects of the infection.

How Hip Replacements Get Infected

Hip replacement implants can become infected at the time of the initial surgery, or may be infected months or years down the road.  Knowing the exact source of infection can be difficult, and many times it is never clear how the infection developed.

  Some patients are more susceptible to developing infection of joint replacements.  Some of the risks of developing a hip replacement infection include:

  • Diabetes
  • Malnutrition
  • Smoking
  • Obesity
  • Steroid use
  • Alcoholism
  • Rheumatoid Arthritis

Prevent Hip Replacement Infection

As stated above, the ultimate goal is to prevent infections before they occur.

There are steps that can be taken at the time of surgery to prevent the risk of surgical infection.  Some of these include pre-surgical cleansing of the skin, clipping hair (not shaving) from the surgical site, giving antibiotics at the time of surgery, and keeping the operating room environment perfectly sterile.  Surgical incisions should be kept clean until healed, although not every surgeon agrees about when showering is allowed.  There is also great debate about the safety of dental work after joint replacement.  Many surgeons continue to have patients take antibiotics when having dental work, although newer research shows this in not necessary for routine dental treatment.

Treatment of Infection

Hip replacement infections are typically separated into early infections (within 6 weeks of hip replacement surgery) and late infections (more than 6 weeks after surgery).  Early infections are typically attributed to contamination at the time of surgery.  The most common source of bacteria is from your skin.

  That's why hospitals are taking many steps to prevent skin contamination, including pre-surgical cleansing of the hip, sterile procedures in the operating room, and antibiotics at the time of surgery.

Early infections are typically treated with a surgical procedure to clean out the infection, followed by a course of antibiotics for several weeks or months.  The hip replacement implants are usually kept in place, and cleansed at the time the surgical incision is thoroughly washed.  Your surgeon may choose to remove some parts of the hip replacement implant to allow for optimal cleansing of the entire wound.  Most often, IV antibiotics are continued for at least several weeks, and additional surgical procedures may be recommended to repeat the washing of the wound.

Late infections are typically thought to be the result of contamination of the hip replacement parts from the bloodstream.  Patients who have bacterial illnesses that enter their bloodstream (septicemia) may develop infection of their implanted joints.  Late infections are more difficult to treat, as the bacteria attach to the implants making their removal difficult, even with surgery and antibiotics.  More often, the hip replacement implants need to be removed entirely in order to cure these late infections.  Depending on the severity of the infection, your surgeon may implant new hip replacement parts immediately (a one-stage revision), or they may opt to delay revision hip replacement until the infection is cured (a two-stage revision). 

Success of Treatment

A hip replacement infection is a serious complication, but the majority of patients do ultimately find successful eradication of the infection with a functional hip replacement joint.  Success rates vary by study, but are in the 70-90% range.  Some of these patients require multiple surgical procedures and may require months of antibiotic treatment.

The concern is that patients who have infections tend to have less successful functional recovery, even if the infection is cured.  These patients have more weakness, more of a limp, and their replacements may not last as long.  Therefore, the importance of prevention is key, and when infections develop they are typically treated aggressively.


Senthi S, Munro JT, Pitto RP. "Infection in total hip replacement: meta-analysis" Int Orthop. 2011 Feb;35(2):253-60. Epub 2010 Nov 18.

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