Joint Replacements

As people age, their joints can become painful, sometimes severely affecting their quality of life. Joint replacements (arthroplasties) for the knee, hip, shoulder, and other joints are now common surgeries. Their successful outcomes can change lives.

Joint replacements are major surgeries however, with the risks that come with surgery. Infection in the surgical wound or joint itself is one of those risks.

According to the American Academy of Orthopaedic Surgeons, about one patient out of every 100 who undergo a hip or knee replacement develops an infection. Regardless of where the infection is, it could lead to sepsis.

Sometimes incorrectly called blood poisoning, sepsis is the body’s life-threatening response to infection. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.

Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Bacterial infections are the most common cause of sepsis. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly), and/or amputations.

Surgery is performed under sterile conditions. All objects introduced or implanted in the body are sterilized to minimize the risk of infection. However, there is always a small chance that bacteria can still appear on the implant or hardware and cause a bacterial infection. And since the bacteria are inside the implant instead of exposed directly to body tissue, it can be more difficult for your immune system to detect and fight the bacteria.

Why do joint replacements?

Surgeons perform total and partial joint replacements to replace damaged or diseased parts of the joint. Damage may be due to a trauma (motor vehicle accidents or falls, for example), or worn down by arthritis or other joint conditions.

Do joint replacements put you at risk for infection and sepsis?

Most people who undergo joint replacements heal well, without any complications. However, any type of surgery does increase your risk of developing an infection, which can in turn cause sepsis.

Risks include developing pneumonia following surgery or contracting a healthcare-acquired infection (HAI) during your stay in the hospital. As well, some people who undergo joint replacements may be older and/or have underlying disease conditions, such as diabetes or COPD, that may make them susceptible to infections.

Infection signs and symptoms

Implant and incision infections have similar signs and symptoms to other infections. They are also related to the location of the affected joint. Signs and symptoms include:

  • Increasing redness around the incision
  • Increasing pain
  • Pus or other fluid coming from the incision
  • Warmer than usual skin around the incision
  • Increased pain around the incision
  • Fever
  • Fatigue

If an infection occurs within the joint, you will likely have increasing pain in the joint as well as some of the above symptoms. Infections in the incision  usually occur within a few days of surgery, while the skin is healing. However, joint infections can occur days to years later. It is important to report any increase in pain in your artificial joint, especially any signs of an infection.

Treating the infection

The first step for treating an infection in an artificial joint is to administer intravenous (IV) antibiotics.

Sometimes the infection is too deep to respond to antibiotics. But if the surgery was recent, your surgeon may choose to clean out the joint surgically. This procedure, called debridement, allows the surgeon to remove any contaminated tissue and thoroughly clean out the joint, but keep the initial replacement. You may need intravenous antibiotics for about six weeks after the procedure.

Later infections, those that occur months or years after the implant, are more difficult to treat. Your surgeon may need to remove the implant. The joint is then thoroughly cleaned out. A temporary spacer is inserted into the joint so it can heal. Antibiotics treat the infection. Once the infection is completely gone, your surgeon removes the spacer and inserts a new artificial joint.

Preventing a joint replacement infection

You and your care team can reduce risk of infection. While arranging your surgery, speak with your surgeon about infection prevention procedures and what you can do to help reduce your risk. Your doctor may suggest:

  • Preoperative testing for bacteria in your nasal passages by a nasal swab.
  • Preoperative wash of your skin with a special soap at home before the surgery.
  • Giving you antibiotics while you are in the operating room and for at least 24 hours after surgery.
  • Recommending preventative (prophylactic) antibiotics before you have any procedures that could put you at risk for an infection. Examples include dental surgery or other surgical procedures.

Finally, eat a healthy diet. Malnutrition, not consuming enough nutrients for your needs, can lower your body’s ability to fight infection.

If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.

Suggested Citation: Sepsis Alliance. Sepsis and Joint Replacements. 2022. https://www.sepsis.org/sepsisand/joint-replacements/

Updated  April 11, 2022.

Read Personal Stories of Sepsis and Joint Replacements

Theresa C.

Survivor

I am 66 years old. In mod July of 2020 I had hip replacement surgery. (Sepsis and Surgery, Sepsis and Joint Replacements) I had had one four years previously with no complications. The day after I was released from the hospital I became disoriented, not know what day it was, unable to remember the code on my phone. I had no other symptoms. But I knew that there was something seriously wrong with me. I told my son to call 911 and thankfully he did. I don’t remember the ambulance ride or the ER. I woke up a time or ... Read Full Story

Submit Your StoryView More Stories

Pam S.

Survivor, Survivor

“I just knew”, was my response to the ER nurse when she asked me how I knew to call for an ambulance that night in March 2017. After over a week of low BP, low body temp, chills, etc., and all I was able to do is move from laying on the sofa, to my bed. Then my temp spiked to over 103 and I was delirious. I had an untreated sinus infection, and had a hip replacement a few months prior that lead to sepsis. (Sepsis and Bacterial Infections, Sepsis and Surgery, Sepsis and Joint Replacements)  Treated for sepsis ... Read Full Story

Submit Your StoryView More Stories

William Lavelle

Survivor, Survivor, Survivor

Writer is a 58-year-old male, now retired /disabled. I am a survivor of two separate sepsis events. It’s no surprise that after 10 years of football into division II., USMC, and giant slalom racing that my knees wore out early. By age 25, I was told the knees are shot and to delay surgeries until I could not take the pain any longer. By 50 years of age, I gave in and had my first left knee replacement. Seventeen months later I had my second knee replacement in spring of 2012. All was going very well albeit my ortho surgeon ... Read Full Story

Submit Your StoryView More Stories

Beth C.

Survivor, Survivor, Survivor, Survivor

My left hip was replaced in 2007 due to osteoarthritis. In October of 2015, I was near the end of a work day on Thursday and when I stood up from my desk an excruciating pain shot through my left thigh. I had no idea why and thought I must have pulled a muscle. I struggled to finish my job and drive home. (Sepsis and Joint Replacements) The next day I went to my PCP and she agreed and prescribed pain meds and bed rest. The pain didn’t improve and I grew weaker each day. I began using a walker ... Read Full Story

Submit Your StoryView More Stories

Joint Replacements

As people age, their joints can become painful, sometimes severely affecting their quality of life. Joint replacements (arthroplasties) for the knee, hip, shoulder, and other joints are now common surgeries. Their successful outcomes can change lives.