Understanding Prosthetic Joint Infection: Prevention, Early Signs & Management

Understanding Prosthetic Joint Infection: Prevention, Early Signs & Management

Verified By
KIMS-SUNSHINE
Specialist,
23 November, 2025

Prosthetics are artificial joint implants that are a replacement for a damaged natural joint like hip, knee or shoulder. Prosthetics are designed to reduce pain and improve mobility of an injured or damaged bone or cartilage. These are composed of metal, ceramic or other biomaterials. Anything that is associated with these prosthetics enters or affects the surgical site – like bacteria, fungi or other pathogens, either internally or externally. These can eventually destroy and damage the prosthetic joint and its components.  Prosthetic joint infections (PJI) in India most commonly occur due to staphylococcus bacteria and drug resistant bacteria like pseudomonas and klebsiella. Some fungal infections from candida species also cause these infections internally. The risk of a PJI is higher if you suffer from comorbidities like diabetes, chronic kidney disease, rheumatoid arthritis etc. The overall prevalence of these prosthetic joint infections is around 2% worldwide, including in India. Mostly these prosthetic joint infections are the reason for failure and revision of knee and hip joint replacements.

Prosthetic Joint Infection (PJI) And Its Early Symptoms:

Prosthetic joint infections are serious complications post joint replacement surgeries. These infections are usually common when they affect the incision site or wound, ranging between a few days up to 3 months post surgery. But in some complicated cases, this infection can spread from incised skin into the internal prosthetic by infecting the artificial prosthetic joint and its surrounding tissues. This kind of complication usually happens or is expected within the first 2 years post joint replacement surgery.

Patients with high risk conditions like diabetes, who smoke, obesity, rheumatoid arthritis, weak immunity or have an active infection elsewhere in the body, repeated joint replacements and in cancerous conditions tend to frequently be a victim to PJI recurrences. Other factors like long hours of surgery and prolonged rehabilitation can also be a leading cause for worry.

Early Symptoms Of PJI Include:

1. Frequent fevers post surgical procedures is an indication of an active infection.
2. Pain, redness and warmth at the incision site.
3. Inflammation and swelling of the operated joint.
4. Drainage from the incision site.
5. Stiffness of the replaced joint is associated with pain after it has been pain free for some time.
6. Fatigue.

A physical examination is done at the affected site and if PJI is suspected, the physician calls for blood tests and cultures as an initial assessment. These can then be followed by other diagnostic tests like needle aspiration, bone scan, CT/MRI and tissue biopsies depending on the necessity and severity of symptoms.

These tests help the physician ascertain the problem in greater detail and plan appropriate treatment. This can start with antibiotic infusions given directly to the affected joint through a catheter. Infected and dead tissue is removed, leaving the prosthetic intact by reopening the joint or an entire revision surgery is done by replacing the prosthetic as a whole. When a patient experiences disabling pain, loose implant or implant breakage, recurrent dislocation or bone injuries around the implant, amputation or complete removal of the infected joint or limb is performed. But, this happens very rarely. 

Prevention of PJI can happen through multiple pre-operative and peri-operative measures. Pre-operative techniques include optimization of known risk facts or modifying them prior to surgery, improving nutrition, and patients undergoing the replacement surgeries are provided with antiseptic cloths a night before the surgery. Peri-operative techniques involve administration of antibiotics an hour before the surgery, maintenance of a sterile environment, reducing sugar intake and using skin antiseptics respectively.

Conclusion

Prosthetic joint infections are highly common in high risk patients such as uncontrolled diabetes, cancer or if they smoke etc. Undergoing such replacement surgeries without proper management and hygiene may cause infections, especially if these individuals are in their  middle and old ages – where post surgical recovery can be very poor. Special attention should be paid to a person’s routine- before and during surgery. Post operative safety measures and follow ups should still be done regularly. Continued surveillance of the prosthetics post surgery, addressing infections and managing them on a timely basis can prevent further damage and complications.

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