Early (<3m after surgery)

defining characteristics

Acute onset joint pain, effusion, erythema, warmth, fever

disease development

Acute contiguous infection from virulent pathogens seeded after surgery

potential causes

S. aureus, Streptococci, Gram – rods, enterococci, anaerobes, fungi (rare)


Rising incidence w/ increased joint replacement surgeries

risk factors

Joint replacement


XR? Lucency at bone/cement interface, loose cemented prosthesis
Synovial fluid aspiration? Elevated WBCs w/ increased neutrophils
Synovial fluid Cx may be negative if biofilm formation Sonication of removed prosthesis for cx

conventional treatment

One-step procedures (remove and replace prosthesis at same time)
Two step procedures (debridement, removal, then replacement later)
debridement and retention (stable joint w/ early inf)
long term Ab (3-6m) for all