Understanding Surgical Treatment for Joint Replacement Infection

An infection can occur after you’ve had a joint replacement. A mild infection that occurs at the incision site may be treated with antibiotics alone. But sometime an infection goes deeper, into and around the artificial joint. Then surgery is needed to clean out the infected area. The artificial joint may also be replaced. There are 2 types of surgical treatments that may be done. The type you have will depend in part on when the infection is found:

  • Debridement. This is done when a deep infection is found early. This means it’s found a few days after symptoms start or a few weeks after your joint replacement surgery. For this procedure, infected tissue is washed out (debrided) from the joint. But the artificial joint stays in place.
  • Staged revision surgery. This is done when a deep infection is found months or even years after your joint replacement surgery. These infections can be harder to get rid of. In these cases, the infected artificial joint is removed and replaced. Infected tissue is also washed out (debrided) from the joint area. This type of surgery can be done in 2 stages over a few weeks or months (2-stage revision surgery). This is the most common type in the U.S. Or in some cases it can be done all at once in 1 procedure (1-stage revision surgery).

Your surgeon will talk with you about which type of procedure you will have.

Why surgical treatment for joint replacement infection is done

Joint replacement infections can be hard to treat. This is especially true for deep infections that aren’t found for weeks, months, or even years after the joint replacement surgery. Over time, germs (bacteria) stick to the artificial joint. They form a layer called a biofilm. The biofilm protects the bacteria from the body’s immune system and from many antibiotics. To fully clear the infection, surgery is needed to wash out (debride) all of the infected tissue. Often the artificial joint needs to be replaced. After surgery, long-term antibiotics may be needed.

How surgical treatment for joint replacement infection is done

Here is what you can expect, depending on the procedure you have:

Debridement

  • The surgeon makes a cut (incision) in the infected joint.
  • All the infected soft tissue is washed out (debrided) and removed.
  • The surgeon cleans the artificial joint.
  • All plastic spacers or liners from your past joint replacement surgery are removed and replaced with new ones.
  • The incision is closed up.
  • After this surgery, you will be given antibiotics by IV (intravenously) for about 6 weeks. You may also need to take antibiotics by mouth (oral) afterward.

Staged revision surgery

This procedure can be done 2 ways:

  • Two-stage revision. This is the standard type of revision surgery in the U.S. It’s done in 2 stages over several weeks or a few months.
  • Single-stage revision. For this surgery, artificial joint removal and replacement is done in 1 procedure:

Two-stage revision

Stage 1:

  • The surgeon makes an incision in the infected joint.
  • The infected artificial joint is removed and the joint area is washed out (debrided).
  • The surgeon inserts a short-term antibiotic spacer to take the place of the artificial joint. The spacer is made with an antibiotic-filled cement. These antibiotics spread into the nearby tissue. This helps fight the infection.
  • The incision is closed.
  • After the surgery, you are given antibiotics by IV for 6 weeks or more. You will keep taking the antibiotics until lab tests show that the infection is gone.
  • When the infection is gone, you are ready to have a new artificial joint inserted in Stage 2.

Stage 2:

  • The surgeon makes an incision in the joint area.
  • The surgeon removes the antibiotic spacer.
  • The joint area is washed out again and checked for signs of infection.
  • If there is no infection, a new artificial joint is inserted. It may be put in place using an antibiotic-filled cement. This is for added protection against infection.
  • The incision is closed.
  • After the surgery, you will be given antibiotics by IV (intravenously) for about 6 weeks. You may also need to take antibiotics by mouth (oral) afterward.

Single-stage revision

  • The surgeon makes an incision in the infected joint.
  • The infected artificial joint is removed.
  • The joint area is washed out (debrided).
  • The surgeon inserts a new artificial joint. It may be placed using an antibiotic-filled cement. This is for added protection against infection.
  • The incision is closed.
  • After the surgery, you will be given antibiotics by IV (intravenously) for about 6 weeks. You may also need to take antibiotics by mouth (oral) afterward.

Risks and possible complications

All procedures have some risk. Risks and possible complications of surgery for joint replacement infection include:

  • A new infection occurs
  • Damage to the joint, tendons, nerves, or blood vessels
  • Blood clots