Evidence guide
Hip replacement infection: rates, signs and prevention
Infection around a hip replacement is uncommon, but it's one of the most serious complications. Here is what the research shows.
The short answer
- In a large Medicare sample, about 1.6 in 100 hip replacements became infected within two years.8
- A smaller number, about 0.6 in 100, became infected between two and ten years later, so the risk never fully goes away.8
- Treatment almost always involves surgery as well as antibiotics.
- Smoking roughly doubles the odds of infection; stopping helps.9
How common is it?
In a Medicare sample of almost 40,000 hip replacements, 1.63% developed a deep infection within two years and another 0.59% between two and ten years. Other health conditions and longer operations were among the risk factors.8
Warning signs
- Fever or chills
- Redness, warmth or drainage from the incision
- Increasing pain, or new pain after a period of feeling well
Call your surgeon's office the same day if you notice these. Don't start antibiotics on your own before you've been seen, since that can make the infection harder to diagnose.
Treatment
Treatment depends on how soon the infection is found. Early infections can sometimes be treated by cleaning out the joint and changing some parts. Later infections often need the implant removed and replaced, in one or two operations, plus weeks of antibiotics.1
Lowering your risk
- Stop smoking before surgery. Current tobacco users had about twice the odds of infection compared with non-users.9
- Manage diabetes and other health conditions before surgery.
- Treat skin and dental problems before surgery.
- Keep the wound clean and dry and follow your team's instructions.
Annual US hospital costs of hip PJI are projected at $753 million by 2030, driven mainly by rising volume.10
Sources
- Ferguson RJ, et al. Hip replacement. Lancet. 2018;392(10158):1662-1671. doi:10.1016/S0140-6736(18)31777-X
- Ong KL, et al. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty. 2009;24(6 Suppl):105-109. doi:10.1016/j.arth.2009.04.027
- Bedard NA, et al. Tobacco use and risk of wound complications and periprosthetic joint infection: a systematic review and meta-analysis of primary total joint arthroplasty procedures. J Arthroplasty. 2019;34(2):385-396.e4. doi:10.1016/j.arth.2018.09.089
- Premkumar A, et al. Projected economic burden of periprosthetic joint infection of the hip and knee in the United States. J Arthroplasty. 2021;36(5):1484-1489.e3. doi:10.1016/j.arth.2020.12.005