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Periprosthetic hip infection

Checked: 23-03-2023 by Vicky Ryan Next Review: 23-03-2025

Overview

The page below gives primary care clinicians guidance on how to recognise and refer a patient with a possible prosthetic joint infection following hip replacement surgery.

Prosthetic Joint Infection (PJI)

Deep infection around a prosthetic joint that can result in severe pain, disability, or death.
Incidence within 2 years of primary hip replacement ranges from 0.8 – 2.1%.
Risk factors: males, previous revision surgery, previous hip infection, hip replacement for rheumatoid arthritis, femoral bone graft during primary hip replacement, smokers, people with a history of steroid administration or body mass index ≥30 kg/m², and those with significant co-morbidity (including liver disease, diabetes, chronic pulmonary disease, heart failure and depression).
PJI has a significant physical, social and psychological impact.

Full Guidelines

INFORM Guideline for hip PJI_v1.2.pdf (bristol.ac.uk)

Who to refer

A prosthetic joint infection should be suspected in:

Any patient within the first four weeks of primary joint replacement with increasing discharge, reduction in function, worsening erythema.
Any patient with a previously well performing hip replacement, who develops symptoms consistent with infection (such as fluid discharge, new or worsening erythema and new or worsening pain) which persists for more than 48 hours.

Early recognition is crucial to prevent progression to a severe, life-altering condition that is difficult to treat and potentially leads to severe disability or death.

If in doubt, contact your local hospital and treating orthopaedic department.

Do not start antibiotic treatment in the community

Without identification of the infecting organism, pre-emptive treatment with antibiotics in primary care may delay identification of the infecting organism or make decision making and surgical management more difficult. The orthopaedic team must collect samples before antibiotics are started to optimise identification of the infecting organism.

Red Flags

All patients with suspected peri-prosthetic joint infection should be dealt with on an urgent basis as outlined above.

If a patient presents with signs of sepsis then call 999 / arrange emergency transfer to ED.

Referral

Where PJI is suspected DO NOT DELAY in referral to treating orthopaedic team.

Referral can be made back to the treating Orthopaedic team in hours, or to the on call team (available via switchboard) at the local hospital/trauma unit out of hours.

Resources

Evidence

“Approach to patients with a potential prosthetic joint infection”. BMJ 2022; 376 doi:

https://doi.org/10.1136/bmj-2021-069502

Regional/Tertiary Prosthetic Joint Infection Services

Prosthetic Joint Infection Service | North Bristol NHS Trust (nbt.nhs.uk)

Guidelines

INFORM Guideline for hip PJI_v1.2.pdf (bristol.ac.uk)

Mental health

Consider referral to NHS Talking Therapies for mental health support.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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